Question of the Week | Assessing for Food Insecurity with Diabetes
Food insecurity affects 16% of adults with diabetes compared with 9% of adults without diabetes.
Based on the ADA standards of care, which is the most accurate statement regarding food insecurity and people with diabetes?
- Food insecurity is defined as uncertain availability of nutritionally adequate food at least once a week.
- Conduct food insecurity screening and income assessment once every 3-5 years.
- Any health care team member can screen for food insecurity using The Hunger Vital Sign.
- People with food insecurity are less likely to experience hyperglycemia due to decreased caloric intake.
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Want to learn more about this question?
Virtual DiabetesEd Training Conference – Join us Live
April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
March 2024 eNews | Plant Based Eating, Untangling Weight Stigma, Mohammed Ali Shares a Recipe for Life
Happy March
We love celebrating National Nutrition Month and the registered dietitian nutritionists who help us maintain the pleasure of eating while empowering us to make informed decisions about daily food choices.
We are honored to highlight the significant impact RDNs have on individuals, communities, and society as a whole by promoting healthy eating habits, preventing disease, and improving our overall quality of life by encouraging us to eat a rainbow of foods filled with fiber and phytonutrients.
In this newsletter, we explore different types of plant-based diets and recognize that accumulating evidence supports the benefits of this approach, including the prevention of type 2 diabetes. We include lots of additional resources to explore and share.
Next, Coach Beverly shares a personal story about confronting weight stigma during a provider visit. She asks readers to raise awareness in their settings and advocate for weight-inclusive and respectful care for each individual.
We share Mohammed Ali’s “Recipe for Life” as we consider including this recipe and all of its’ ingredients in our daily lives.
Our guest contributor, Nick Kundrant, provides insights into the transformative power of a positive mindset based on his book, “Positively Type 1”. His message of empathy, resilience, and a holistic approach to health care is inspiring, Thanks, Nick!
Finally, we are excited to announce our “Connect with Coach Beverly” live Facebook event on March 13th! Test your knowledge with our nutrition-inspired Questions and Rationales of the Week!
Sending notes of joy and health,
Coach Beverly, Bryanna, Brent, Christine, Andrew, and Ginger
Featured Articles
- Plant Based Eating – What Approach is Best?
- Untangling Weight Stigma at Medical Appts
- Recipe for Life
- Coach Beverly Connects – Airs March 13th
- Positively Type 1 – Guest Blog by Nick Kundrat
- Question of the Week
- Rationale of the Week
Upcoming Webinars
- Behavior Change Theories Made Easy – March 20
- Prep for CDCES – March 21
- Microvascular Disease – Reducing Risk on April 11th
- Cardiovascular Disease & Diabetes – April 13
- Virtual DiabetesEd Training Conference – April 17-19
- ReVive 5 – May 22nd & 29th
- Upcoming Events – See the complete calendar listing
Upcoming Events – See the complete calendar listing
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
- Conference Schedule >
- Conference Flyer >
Click Here for Registration Options
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | Best action to address sudden Hyperglycemia due to Cellulitis?
For last week’s practice question, we quizzed participants on addressing sudden hyperglycemia due to cellulitis. 66% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question: RL is 83, has Latent Autoimmune Diabetes, and takes degludec 17 units every morning along with metformin 500 XR twice daily. RL tells you that their left leg was suddenly swollen and red, so they went to urgent care and were started on a course of antibiotics. In the meantime, their CGM is showing elevated blood sugars in the 200 to 350 range during the day but often less than 100 at night. RL weighs 70kg, with a BMI of 23.4.
Based on this information, what action do you suggest?
Answer Choices:
- Decrease carbohydrate intake by 20-25% until the infection subsides.
- Increase the degludec by 20% to get blood glucose levels to target.
- Encourage RL to walk after meals to decrease post prandial blood sugar levels.
- Suggest initiation of bolus insulin once or twice daily.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 10.02% chose this answer. “Decrease carbohydrate intake by 20-25% until the infection subsides.” Since RL has elevated glucose levels due to infection, drastically decreasing carbohydrate intake is not the best approach to manage glucose levels. We want to ensure RL has adequate nutrition given her infection and age.
Answer 2 is incorrect. 15.36% of you chose this answer. “Increase the degludec by 20% to get blood glucose levels to target.” It seems that RL needs more insulin to lower daytime glucose levels. However, RL is experiencing glucose levels less than 100 overnight, which puts them at risk of nocturnal hypoglycemia. If we increase basal insulin by 20%, this dramatic increase could cause a dangerous drop in overnight glucose levels and is not recommended.
Answer 3 is incorrect. About 8.68% of respondents chose this. “Encourage RL to walk after meals to decrease post prandial blood sugar levels.” Keeping active is always a good idea, but with blood sugars running 200-350 during the day, walking after meals won’t be enough to get glucose levels to target. Plus, it may not be safe to promote walking since they have an infection and a leg that is swollen and red.
Finally, Answer 4 is correct. 65.94% chose this answer. “Suggest initiation of bolus insulin once or twice daily.” YES, this the best answer. Counterregulatory hormones are released during periods of infection that contribute to insulin resistance and hyperglycemia. To get blood glucose levels to target, RL will need daytime bolus insulin to manage the hyperglycemia, which will promote healing. Of course, treatment with antibiotics will also help to lower glucose levels.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
Registration Options
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | RS Doesn’t Want to Get Weighed
For last week’s practice question, we quizzed participants on how to approach a person who does not want to be weighed during a quarterly diabetes appointment. 60% of respondents chose the best answer. If you are interested in learning more about the importance of providing weight inclusive care, this practice test question will set you up for success.
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it here: Answer Question
Question:
RS arrives at their quarterly diabetes provider appointment and the medical assistant walks them to the scale, in the clinic hallway, to get their weight. RS politely explains that they feel uncomfortable being weighed but they are happy to share their stated weight. The medical assistant once again encourages RS to get on the scale and reassures RS that they don’t need to look at or know their weight. RS sighs, takes off their shoes and reluctantly gets on the scale to be weighed.
Which of the following best describes the end result of this situation?
Answer Choices:
- The medical assistant used a person-centered approach to respect the wishes of RS.
- RS exhibited non-adherence and reconsidered their request.
- According to the transtheoretical model, RS was in preparation stage and needed gentle encouragement.
- The clinic staff would benefit from an inservice on providing weight inclusive care.
Getting to the Best Answer
If you are interested in providing weight inclusive care, this practice test question will set you up for success. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is incorrect. 15.91% chose this answer. “The medical assistant used a person-centered approach to respect the wishes of RS.” Instead of honoring the request to not be weighed, the medical assistant insisted RS step on the scale. A person centered, weight inclusive approach would respect RS’s request not to be weighed and accepted their stated weight.
Answer 2 is incorrect. 8.39% of you chose this answer. “RS exhibited non-adherence and reconsidered their request.” People with diabetes have the right to be weighed in a private space and they also have the right to decline to be weighed. In this situation, RS’s weight is not required to provide safe and effective medical care.RS is not “non-adherent”, they are simply expressing their need not to step on the scale.
Answer 3 is incorrect. About 15.70% of respondents chose this. “According to the transtheoretical model, RS was in preparation stage and needed gentle encouragement.” This juicy answer does not reflect the situation in the medical office at the scale. RS did not state that they were working on being comfortable with being weighed or that it would be helpful to be weighed. Instead RS told the MA twice that they don’t want to be weighed, but their request was not honored.
Finally, Answer 4 is correct. 60% chose this answer. “The clinic staff would benefit from an inservice on providing weight inclusive care.” YES, this is the best answer. If the staff were informed about weight inclusive care and reducing weight stigma, they would have honored RS’s request not to be weighed and documented their stated weight. This inclusive approach would help RS feel seen, heard and respected. RS would gain a positive association with their medical team and be more likely to return for future appointments.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this important learning activity!
Want to learn more about Weight Stigma?
Enjoy our blog – Untangling Weight Stigma at Medical Visits.
Weight stigma in medical appointments is a significant issue that can have detrimental effects on the individuals’ physical and mental health. It refers to the negative attitudes, beliefs, and stereotypes healthcare providers may hold towards individuals with extra weight. This stigma can manifest in various ways during medical appointments, including biased treatment, assumptions about the person’s lifestyle or health behaviors, and even neglect of legitimate health concerns unrelated to weight.
Although I disguised this question and situation as happening to RS, this question is based on my own personal experience. My goal in sharing this with all of you is not only to raise awareness of this often-overlooked barrier to care but a call to take action in our places of work to provide more weight inclusive environments.
Action Steps to Untangle Weight Stigma in Medical Appointments:
Awareness and Education: participate in training programs to help care providers recognize and address weight bias. A great resource is Inclusive Diabetes Care.
Language Matters: Use neutral and respectful language when discussing weight-related issues.
Focus on Health, Not Weight: Shift the focus of medical appointments from weight to overall health and well-being.
Individualized Care: Recognize the individual and understand their story around weight.
Create Supportive Environments: Design healthcare settings that are inclusive and welcoming to individuals of all sizes.
Advocate for Systemic Change: Addressing weight stigma requires systemic change within the healthcare system and society as a whole. Healthcare providers can advocate for policies that promote health equity, combat weight bias in research and media, and support initiatives that address social determinants of health.
By implementing these strategies, healthcare providers can help untangle weight stigma in medical appointments and create a more supportive and inclusive environment for all patients, regardless of their size.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Question of the Week | Best Approach for Religious Fasting?
Ramadan is observed by Muslims worldwide as a month of fasting (sawm), prayer, reflection, and community. The common practice is to fast from dawn to sunset. The pre-dawn meal before the fast is called the suhur, while the meal at sunset that breaks the fast is called iftar. This year, Ramadan starts on Sun, March 10th and ends Tuesday April 9th, 2024. This question of the month addresses supporting individuals with diabetes during periods of religious fasting.
The 2024 Standards of Care reported individuals who fast have an increased risk for hypoglycemia, dehydration, hyperglycemia, and ketoacidosis.
Which of the following is an accurate health care statement regarding recommendations for religious fasting?
- Recommend continuing with usual diet and medication regimens to ensure glucose stability and reduce health risks.
- Accommodate a person’s choice for religious fasting.
- Advise people with diabetes taking insulin about the need to avoid religious fasting due to risk of hypoglycemia.
- Provide education on religious fasting only when evidence indicates risk.
Click Here to Test your Knowledge
Question of week contributed by Christine Craig, MS, RD, CDCES, winner of the 2023 Impact on Diabetes Award, is a leader in the field of nutrition, technology, and diabetes care. Her years of expertise combined with her person-centered approach and work ethic, make her a perfect Question of Week author for this nutrition and activity focused content.
Want to learn more about this question?
It’s not to late to join our 2024 Boot Camp Series
Ends March 19th, 2024, at 11:30 am PT
Not too late to enroll in Boot Camp and learn from our nutrition expert, Christine Craig, MS, RDN, CDCES
Class Topics & Webinar Dates:
- recorded – Boot Camp 1: Diabetes | Not Just Hyperglycemia | 1.75 CEs
- recorded – Boot Camp 2: Standards of Care & Cardiovascular Goals | 1.8 CEs
- recorded – Boot Camp 3: Meds for Type 2 | What you need to know | 1.75 CEs
- recorded – Boot Camp 4: Insulin Therapy | From Basal/Bolus to Pattern Management | 1.75 CEs
- recorded – Boot Camp 5: Insulin Intensive & Risk Reduction | Monitoring, Sick Days, Lower Extremities | 1.75 CEs
- recorded – Boot Camp 6: Medical Nutrition Therapy | 1.75 CEs
- March 12, 2024 – Boot Camp 7: Microvascular Complications & Exercise | Screen, Prevent, Treat | 1.75 CEs
- March 14, 2024 – Boot Camp 8: Coping & Behavior Change | 1.75 CEs
- March 19, 2024 – Boot Camp 9: Test-Taking Coach Session (48 Questions) | No CE
Intended Audience: This library of critical information is designed for individuals or groups of diabetes specialists, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in staying up to date on current practices of care for people with diabetes and preparing for the BC-ADM or the CDCES certification Exam.
Can’t make it live? No worries. We will send post the recorded version to the Online University within 24 hours of the broadcast
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 20 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert. She has a Master’s Degree in Public Health from UCLA, with a focus on behavioral health and education.
Christine Craig, MS, RD, CDCES, winner of the 2023 Impact on Diabetes Award, is a leader in the field of nutrition, technology, and diabetes care. Her years of expertise combined with her person-centered approach and work ethic, make her a perfect speaker for this nutrition and activity focused content.
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
First Over-the-Counter CGM Stelo – Cleared by FDA
KL lives with type 2 diabetes and takes metformin and a SGLT-2i to keep blood sugars on track. KL is making a significant lifestyle changes and wants to closely monitor the impact on glucose levels throughout the day. KL asked their provider about getting a continuous glucose monitor (CGM) sensor, but insurance won’t covers since KL is not on insulin and is not at risk for hypoglycemia.
KL has made monumental changes in their approach to food choices and is going to the gym at least three times a week to improve their overall health. They want glucose feedback throughout the day instead of an occasional finger stick.
With the FDA approval of the first OTC glucose sensor, Stelo, people like KL can get more detailed information about blood sugar response and trends throughout the day.
Who benefits from the Dexcom Stelo?
The Dexcom Stelo Glucose Biosensor System is an integrated CGM (iCGM) intended for anyone 18 years and older who does not use insulin and wants to better understand how diet and exercise may impact blood sugar levels. Since it does not have low blood glucose alarms, this system is not for individuals at risk of hypoglycemia.
How Does it Work?
The Stelo Glucose Biosensor System uses a wearable sensor paired with an app installed on a user’s smartphone or other smart device to continuously measure, record, analyze, and display glucose values. The device is built on the Dexcom G7 platform, but it does not have alerts and alarms like the G7, and each sensor is made to last up to 15 days rather than 10.
The device transmits blood glucose measurements and trends every 15 minutes in the accompanying app. The company warns users to only make medical decisions based on the device’s output after talking to their healthcare provider.
Data from a clinical study provided to the FDA showed that the device performed similarly to other iCGMs. Adverse events reported in the study included local infection, skin irritation, and pain or discomfort.
Increased Access
Making glucose sensors available without a prescription expands access to these devices by allowing individuals to purchase a CGM without the involvement of a healthcare provider. The hope is that more individuals will have access to valuable information about their health, regardless of their access to a doctor or health insurance.
Drawbacks?
Since this is an out-of-pocket expense, the cost may be prohibitive for some individuals. In addition, having all this data can lead to information overload, especially if the individual is trying to make sense of the numbers without coaching from a healthcare professional.
Cost and Availability
Dexcom plans to make Stelo available this summer. The company hasn’t provided pricing estimates but said the device would be competitive with Dexcom’s current prescription-required device, the Dexcom G7.
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Can’t join live? That’s okay. Your registration guarantees you access to the recorded version of the series, along with podcasts and resources for one full year.
Program Details
- Dates: April 17-19th, 2024
- Registration Fee: $399-$569 (see more about reg. options below)
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
- Speakers: View Conference Faculty
- Conference Schedule >
- Conference Flyer >
Registration Options
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval from the Commission of Dietetic Registration (CDR), Provider DI002. Our programs that have Prior Approval* by the CDR satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession.
The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.
Sign up for Diabetes Blog Bytes – we post weekly Blog Bytes that are informative and FREE! Every week we post one exam practice Question of the Week and Rationale of the Week. Sign up below!
Recent Blog Bytes
- Rationale of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
- Question of the Week | What defines overbasalization according to 2025 ADA Standards?
- Upcoming Webinars!
- Rationale of the Week | Diabetes & Malnutrition Risk
- Cheat Sheet Updates – Reflect 2025 ADA Standards
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Rationale of the Week | What medication changes do you recommend?
For last week’s practice question, we quizzed participants on medication recommendations. 61% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Question:
RL was newly diagnosed 43 with type 2 diabetes 6 months ago with an initial A1C of 10.1%. They have no cardiovascular disease and their renal function is within normal limits. At a recent office visit, you notice RL’s A1C has dropped to 7.3, their BP is 112/78 and the LDL cholesterol is 103mg/dL. RL’s current medication regimen includes, rosuvastatin 10mg, empagliflozin 25mg, metformin 1000 BID, glargine 12 units and aspirin 81mg.
Based on this information, what changes to RL’s medication plan do you recommend to the provider?
Answer Choices:
-
- Consider increasing rosuvastatin and stopping ASA therapy.
- Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.
- Consider adding an ACE or ARB and increasing basal insulin.
- Consider increasing metformin and decreasing basal insulin.
Getting to the Best Answer
If you are thinking about taking the certification exam, this practice test question will set you up for success. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.
Answer 1 is correct. 60.90% chose this answer. “Consider increasing rosuvastatin and stopping ASA therapy.” – YES, this is the best answer. GREAT JOB. According to the ADA Standards of Care, the goal is to reduce the LDL by 50% and less than 70mg/dL. The max dose of rosuvastatin is 40mg and RL is only on 10mg. Increasing the dose of rosuvastatin will help decrease LDL levels. Aspirin therapy is indicated for people 55 years and older with an elevated CV risk. For those under 55, aspirin therapy is based on their CV risk profile. Since RL has no CV disease, aspirin therapy is not indicated.
Answer 2 is incorrect. 13.76% of you chose this answer. “Consider stopping empagliflozin and starting GLP-1 RA to help with weight loss.” This is not the best answer since there is no reason to stop empagliflozin when starting a GLP-1 RA. In addition, there is no mention in the vignette that RL has weight loss as a goal, so switching from an SGLT-2 to a GLP-1 is not indicated at this time.
Answer 3 is incorrect. About 9.27% of respondents chose this. “Consider adding an ACE or ARB and increasing basal insulin.” This is not the best answer, since the first part of the response isn’t correct. RL has great renal function and their BP is below the target of 130/80, so an ACE or ARB is not indicated at this time.
Finally, Answer 4 is incorrect. 16.07% chose this answer. “Consider increasing metformin and decreasing basal insulin.” This is not the best answer, since the metformin is already very close to the maximum dose of 2,550 mg day and we need more information about the fasting blood glucose levels before increasing the basal insulin. Most importantly, the first answer is a better answer.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Virtual DiabetesEd Training Conference – Join us Live on April 17th – 19th 2024 at 11:30 AM PST
Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, and “aha” moments for our Virtual DiabetesEd Training Conference April 17th – 19th, 2024.
Attendees will leave this conference with new tools and a refreshed understanding of the latest advances in person-centered diabetes care. Our team highlights the ADA Standards of Care, medications, behavior change, technology, medical nutrition therapy, and more!
Our instructors co-teach the content to keep things fresh and lively.
Friend Discount: 3 or more only $449 per person. Email us at [email protected] with the name and email of each registrant to get the discount!
Program Details
-
- Dates: April 17-19th, 2024
-
- Registration Fee: $399-$569 (see more about reg. options below)
-
- Friend Discount: For 3 or more people, each person saves $50 off their registration. Email us at [email protected] with the name and email of each registrant to get the discount!
-
- CEs: 30+ CEs | 18 units for Virtual Conference plus 10+ Bonus CEs. CEs can be applied toward CDCES’s initial application or renewal.
-
- Speakers: View Conference Faculty
Registration Options
Sign up for Diabetes Blog Bytes – we post one daily Blog Byte from Monday to Friday. And of course, Tuesday is our Question of the Week. It’s Informative and FREE! Sign up below!
Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
Does Yogurt Reduce the Risk of Type 2 Diabetes?
Does Yogurt Reduce the Risk of Type 2 Diabetes?
by Christine Craig, MS, RD, CDCES
On March 1st, 2024, the FDA announced they “do not object” to the use of the qualified health claim: “Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes according to limited scientific evidence.”1
When I learned of this announcement, my curiosity perked up; my obsession with yogurt started in the late nineties during a microbiology project in which I plated different over-the-counter yogurts and compared the growth.
I was fascinated by the relationship between probiotics and health, and I learned from my research that not all yogurts were created equal. The ADA Standards of Care have recognized the health of the microbiome is essential for preventing and treating diabetes and still, to date, no specific recommendation has been stated regarding inclusion of yogurt. Probiotics have many beneficial effects, including enhancing the immune system, treating diarrhea, lowering cholesterol, and treating IBD and IBS.
But what about yogurt and diabetes prevention? We know there is more to the microbiome health than just yogurt, but are there specific yogurts we can consider recommending? How can we apply these recommendations practically across eating patterns using person-centered care?
What does the FDA consider yogurt?
The term yogurt likely originates from the Turkish term “yogurmak”, which means to thicken, coagulate, or curdle.2 Although modern times have updated how it is packaged (including many flavors, stabilizers, and texture enhancements), yogurt originated from 5000-10,000 BC when milk was packed into stomach lining sacks, and the curdling process that resulted, served as a natural preservative.2 Today, yogurt is defined by the FDA as a cultured food of one or more basic dairy ingredients, cultured with lactobacillus bulgaricus (l. bulgaricus) and streptococcus thermophilus bulgaricus (s. thermophilus). Probiotic yogurts may contain additional strains of bacteria, such as bifidobacterium lactis or lactobacillus acidophilus but, on the shelf, you can find yogurts with many other probiotic strain additives.
Yogurt, by definition, has a pH of 4.6 or lower and is allowed to be treated after culturing to inactivate viable microorganisms and extend shelf-life.3 However, those treated after culturing must state on the label “does not contain live and active cultures,” and those containing “live and active cultures” must have a minimum of 106 CFU at self-life expectation. Nutritionally, yogurt is a good source of calcium, phosphorus, potassium, Vitamin A, B2, and B12 and has about 8 grams of protein per cup in conventional yogurts.
What is the evidence for diabetes prevention?
Five meta-analyses and additional observation studies were reviewed within the petition to the FDA.4 The most recent, 2016 meta-analysis reviewed 22 prospective cohort studies completed within 4 countries of origin.5 Eleven of the studies evaluated yogurt and they reported a 14% lower type 2 diabetes risk when including at least 80 grams of yogurt per day (~1/3 cup). They found greater significance and confidence within subpopulations, including women or older (>60) adults. Most studies included conventional yogurts with mixed fat content (some including low-fat while others regular-fat). The amount of added sugar or product type (plain vs. sugar-sweetened yogurt) was not reported. We cannot state a specific type of yogurt that resulted the most significant difference. The FDA, in their statement, called out caution regarding high-sugar yogurt products due to potential concern of contributing to excessive sugar consumption, but no restriction was placed on the allowable claim due to the limited evidence.
The qualified health claim applies to food-based products and not supplements.4 We also need to find out if different types of yogurts, including higher protein or plant-based varieties, would have similar outcomes.
Glycemic Benefits of Yogurt in Type 2 Diabetes Management
A 2019 meta-analysis of yogurt’s effects and glycemic outcomes in persons diagnosed with type 2 diabetes reviewed nine randomized control trials.6 Yogurt types included mainly probiotic dairy yogurt (L. acidophilus, B. lactis) but also one from goat milk and one from kefir. They reported that probiotic yogurt showed no significant difference in improving HgbA1c, fasting insulin, fasting glucose, and insulin resistance. However, kefir did show a significant difference in A1c and fasting blood glucose reduction. Again, this meta-analysis did not differentiate between low and regular-fat yogurt nor plain and sweetened yogurts. The analysis also did not consider the synergistic effects of other foods to enhance outcomes nor measured microbiome changes. More studies are needed to include larger populations and differentiation of subpopulations that may show benefit.
Can we suggest any yogurt variety?
In 2023, the US yogurt market grew to a 9.38-billion-dollar industry, with growth in yogurt varieties, including higher protein (Greek, Icelandic type, etc.) and plant-based dairy-alternative yogurt products. Higher protein yogurt varieties are generally lower in sugar and almost double the protein at 15-18 grams per serving, they contain about 10-20% of Vitamin D and Calcium. Plant-based yogurts vary in comparable nutrient content, ranging from 11-20 (or more) grams of carbohydrate, 1-8 grams of protein per serving, 2-20% Calcium, 0-10% Vitamin D, and 0-40% B12, and they typically contain live active cultures.7 To date, limited studies have been conducted on these products and health outcomes. The variety of yogurt products on the shelf does not match the data evaluated within the FDA petition meta-analysis. Yet, it is essential to support individuals with or at risk of diabetes who choose a plant-based dairy alternative that meets their specific nutrient needs.
The ADA Standards of Care and referenced dietary patterns including the Mediterranean Diet, DASH diet, and general healthful eating patterns recommend including 2-3 servings of dairy per day. These eating patterns also recommend limiting added sugars and high-fat dairy. The meta-analysis results do not provide enough information to suggest a specific type of yogurt, so we can work with individuals to learn their dietary patterns and determine if yogurt may be a good substitute or encouraged current food choice. We can assess an individual’s total fat and sugar intake to determine if yogurt is a significant contributor and can find an appropriate option that supports overall dietary patterns and individual metabolic goals. The microbiome’s health is dynamic, and specific food recommendations will likely be synergistic.
Like a healthy plate, no single food or one-size-fits-all approach is appropriate and as we learn more, many functional food options can be relevant to recommend.
References:
1. FDA Announces Qualified Health Claim for Yogurt and Reduced Risk of Type 2 Diabetes. Downloaded on March 12, 2024 from https://www.fda.gov/food/cfsan-constituent-updates/fda-announces-qualified-health-claim-yogurt-and-reduced-risk-type-2-diabetes
2. Hadjimbei E, Botsaris G, Chrysostomou S. Beneficial Effects of Yoghurts and Probiotic Fermented Milks and Their Functional Food Potential. Foods. 2022 Sep 3;11(17):2691.
- CFR-Code of Federal Regulations Title 21: Food and Drugs: Part 131 Milk and Cream. Downloaded on March 13th, 2024. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=131.200&SearchTerm=yogurt
- Petition for the Authorization of a Qualified Health Claim for Yogurt and Reduced Risk of Diabetes downloaded on March 12, 2024 from https://www.regulations.gov/document/FDA-2019-P-1594-0001
- Gijsbers L, Ding EL, Malik VS, de Goede J, Geleijnse JM, Soedamah-Muthu SS. Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies. Am J Clin Nutr. 2016 Apr;103(4):1111-24
- Barengolts E, Smith ED, Reutrakul S, Tonucci L, Anothaisintawee T. The Effect of Probiotic Yogurt on Glycemic Control in Type 2 Diabetes or Obesity: A Meta-Analysis of Nine Randomized Controlled Trials. Nutrients. 2019 Mar 20;11(3):671.
- Craig WJ, Brothers CJ. Nutritional Content and Health Profile of Non-Dairy Plant-Based Yogurt Alternatives. Nutrients. 2021 Nov 14;13(11):4069.
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