Once Weekly Insulin Not FDA Approved due to Safety Issues

Once weekly basal insulin, icodec, failed to be approved for use by people with type 1 diabetes by the FDA’s Endocrinologic and Metabolic Drugs Advisory Committee by a vote of 7-4. The significantly increased risk for hypoglycemia on days two through four after administration outweighed its potential benefits. The committee also noted that icodec’s risk of hypoglycemia is higher than the basal insulin degludec, which is commonly used and has a better safety profile. Other committee members expressed concerns that approving icodec based on inadequate data could discourage further trials that are needed to ensure its safe use.

In an effort to secure approval, the applicants for icodec suggested the following actions to improve the safety profile of this novel weekly insulin.

Proposed mitigating actions to reduce hypoglycemia risk by the applicant included;

icodec only be used for people using a CGM
individuals with hypoglycemia unawareness would not be candidates for this once weekly insulin
labeling alternative insulin dose titration strategies to reduce the risk of hypoglycemia (e.g., reducing the bolus insulin dose by approximately 30% between days 2 to 4 after each weekly insulin icodec injection).
Indicating insulin icodec only for patients with a low % coefficient of variation (%CV) since the subgroup of patients with low glycemic variability, as defined as percent coefficient of variation (%CV<36%), had hypoglycemia risk comparable to the entire cohort of patients on insulin degludec (i.e.,with any %CV).
Recommending that individuals who experience recurrent hypoglycemia switch to other insulin treatment options
Providing prescriber and patient training materials to help maximize benefit-risk.

Even though mitigating actions were suggested to decrease this hypoglycemia risk during this two day peak, the FDA panel members still deferred approval, citing safety concerns due to the significant hypoglycemia risk and need for more data..

How would people living with type 1 diabetes benefit from once weekly insulin?

Surprisingly, about one third of people living with type 1 diabetes are still managing blood sugars with multiple daily injections. This is especially true for people living in under resourced communities and people of color living with type 1 diabetes. Due to barriers and social determinants of health, in addition to struggling with multiple daily injections, they are also less likely to use continuous glucose monitors or check blood sugars on a regular basis. Although, once a week insulin seems ideal for individuals who may be experiencing a variety of barriers to injecting daily insulin, the main issue is the increased risk of hypoglycemia during days 2-4 when icodec is peaking coupled with limited access to glucose monitoring.

In addition, consistent injected insulin therapy in adults with type 1 diabetes was reported to be relatively low (52.6%, 95% confidence interval[CI]: 37.4 to 67.9%) in data from a meta-analysis of eight clinical trials. The probability of missing at least one daily basal insulin dose over any 14-day period is estimated to be 22% (95% CI: 10 to 40%).

Among individuals with type 2 diabetes, using a daily basal insulin, a once weekly basal insulin would reduce the number of insulin injections from 365 per year to 52 per year. In a recent study, 91% of people with type 2 diabetes and 89% of providers had a positive view of taking basal insulin once weekly.

Among individuals with type 1 diabetes, who rely on a basal bolus regimen, a once weekly basal insulin would reduce the number of insulin injections from approximately 28 per week to 22 per week. For those with type 1 diabetes, there is no research to date that evaluates whether a once weekly basal insulin would be preferred over other basal insulin options, or whether use would result in improved adherence and glycemic control.

ONWARDS 6 Study Results – Using icodec for people living with Type 1

In ONWARDS 6, weekly insulin icodec was noninferior (but not superior) to daily insulin degludec and was associated with 48 to 89% more level two and three hypoglycemia at Week 26, depending on the method of analysis. The highest risk period for hypoglycemia with insulin icodec coincides with its peak glucose-lowering effect which occurs on days 2 to 4 following each weekly injection. There were also more hypoglycemia-related serious adverse events reported among patients randomized to insulin icodec compared to insulin degludec.

Thus, in the only study conducted in participants with type 1 diabetes, insulin icodec was observed to have a higher risk of clinically meaningful hypoglycemia, in the absence of a lower A1C. Hypoglycemic episodes reported with insulin icodec and insulin degludec in ONWARDS 6 were of the same nature in terms of duration, management, and recovery.

What is Insulin icodec?

Insulin icodec is an acylated long-acting human insulin analog produced by a process that includes expression of recombinant DNA in yeast (Saccharomyces cerevisiae), followed by chemical modification. In addition to amino acid sequencing changes, a C20 fatty-acid side chain has been added to the peptide backbone via the amino group in the side chain at Lys(B29). When insulin icodec is injected, the C20 fatty acid sidechain derivative binds strongly, but reversibly, to endogenous albumin, which results in decreased renal clearance and protection from metabolic degradation, and consequently prolonged pharmacodynamic activity.

Insulin icodec is a proposed insulin analog with a prolonged duration of action intended to support once weekly (QW) subcutaneous administration. Thus, insulin icodec reduces treatment burden in type 1 diabetes, by reducing the number of basal insulin injections in comparison to daily basal insulins.

However,basal insulin icodec does not have a peakless time-action profile throughout the dosing interval (see chart below).

In conclusion, it seems certain that the manufacturers of insulin icodec will be seeking approval for this once weekly insulin for people living with type 1 and type 2 diabetes in the future. Stay tuned for more insulin updates with our monthly newsletter.

Information from this article was obtained from review of the FDA Presentation Document and Slides, May 24, 2024.

Accreditation: The Diabetes Educator Live Course is approved for 26 Contact Hours for nurses and CA Pharmacists and 21 CPE, Level III for RDs. Provider is approved by the California Board of Registered Nursing, Provider # 12640 and Commission on Dietetic Registration (CDR), Provider # DI002. Need hours for your CDCES? We have great news. This program is accredited by the CDR so all hours of instruction can be used to renew your CDCES regardless of your profession. **

The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.

**To satisfy the requirement for renewal of certification by continuing education for the Certification Board for Diabetes Care & Education (CBDCE), continuing education activities must be applicable to diabetes and approved by a provider on the CBDCE List of Recognized Providers (www.cbdce.org). CBDCE does not approve continuing education. Diabetes Education Services is accredited/approved by the Commission of Dietetic Registration which is on the list of CBDCE Recognized Providers.

Embark Trial Reveals Results – Spoiler Alert

The results of the EMBARK Trial are in! Spoiler Alert: These findings will change your practice approach.

As a Diabetes Educator who participated in the EMBARK trial, I have first-hand experience with the three different approaches used in this study to address diabetes distress and glucose levels for adults living with type 1 diabetes. I am surprised by the findings and excited to share them.

But before I describe the study and its results, there is a spoiler alert—the research results might compel you to adjust your practice approach.

First, let’s start with some background information.

The EMBARK (Behavioral Approaches to Reducing Diabetes Distress and Improving Glycemic Control) study was a 12-month randomized, controlled intervention trial for adults with type 1 diabetes. It directly compared the impact of three highly focused interventions designed to reduce both Diabetes Distress and A1C levels among adults with Type 1 Diabetes.

The trial divided participants into three groups: Streamline, FixIt, and TunedIn. As a diabetes educator, I participated in the Streamline and FixIt study groups. As part of the study protocol, each participant completed the Diabetes Distress Scale and the results were shared with the study facilitators.

In the Streamline educator-led intervention, we instructed individuals with type 1 to get glucose to target through group training, phone calls, and the use of unique glucose logs that promote problem-solving and self-discovery. The group training provided a brief diabetes review focused on basal insulin and bolus dosing and timing, followed by a structured five-step program to identify and resolve the specific glucose challenges identified by each participant.
The Diabetes Educators weren’t involved in the TunedIn intervention group. TunedIn was a psychologist-led program that exclusively targeted the problematic feelings, beliefs, and expectations that underlie diabetes distress. The psychologists led a virtual group workshop followed by individual phone calls, during which they discussed areas of distress and guided participants through a structured conversation to address and reduce distress.
The third group, FixIt, involved both diabetes educators and diabetes psychologists and combined both the Streamline and TunedIn approaches into a single, integrated program.

Which Intervention Worked Best?

As a diabetes educator involved in the Streamline and FixIt groups, I was sure that the FixIt group would have the best outcomes, given that they received the “Rolls-Royce” of interventions, which included several group sessions and one-on-one coaching by a team of psychologists and diabetes educators. However, I was wrong. The psychologist-led “TunedIn” had the best overall outcomes.

Results: TunedIn, an emotion-focused program, had the most consistent overall benefits when considering both Diabetes Distress and A1C (see infographic below).

The findings suggest the value of using emotion-focused strategies, like those in TunedIn, to reduce diabetes distress and enhance management among adults with diabetes. In truth, the findings reveal that all three groups experienced improvement in A1C and Diabetes Distress. These results suggest that both management- and emotion-focused group programs for adults with type 1 diabetes can lead to significant and clinically meaningful reductions in Diabetes Distress and A1C.

As healthcare professionals, we tend to focus on problem-solving around lifestyle, medications, and glucose levels. The results of this study confirm our intuition to prioritize addressing emotions to support individuals living with diabetes.

Let’s reprioritize our checklist of diabetes topics and move into the heart of providing effective diabetes care by assessing and addressing distress.

This emotion-based approach aligns with the 2024 American Diabetes Standards, which recommend annually assessing Diabetes Distress. These important study results remind and prompt us to assess and address Diabetes Distress to improve diabetes care outcomes. The ADA created a wonderful resource, the ADA Behavioral Health Toolkit, which houses diabetes distress and other screening tools for easy reference.

We can incorporate three main approaches underlying this study into our clinical practice (from Embark Trial Article).

Take a diabetes education and management approach that focuses on fostering self-management change. This strategy assumes that people will become less distressed as they engage more effectively with their management.
Incorporate an emotional approach. One key to improving glycemic outcomes is to directly address the feelings, beliefs, and expectations that underlie diabetes distress and serve as barriers to management change. This strategy recognizes that diabetes distress acts as a brake on the application of existing diabetes knowledge and skills and on one’s ability to benefit from new educational and behavioral interventions. By releasing the diabetes distress brake through emotion-focused intervention, the negative cycle can be efficiently ended.
Use an integrated approach that combines an education and management approach with a diabetes distress emotion-centered approach. This capitalizes on the strengths of each, leading to a more effective and efficient strategy for reducing diabetes distress and improving glycemic management.

The year I spent coaching study participants in the Embark Trial significantly changed my approach to diabetes self-management coaching. In preparation for the study intervention, we were fortunate to be mentored by two experts in the field of diabetes distress: Susan Guzman, PhD, and Larry Fisher, PhD. Their wisdom and role-modeling of empowering individuals to discover new approaches to self-management were truly remarkable.

As a result of the Embark training and the Study results, I have finally given myself permission to make addressing the emotional aspects of diabetes a priority. ~Coach Beverly

(image from Embark Trial Study).

Embark Trial Study

Danielle M. Hessler, Lawrence Fisher, Susan Guzman, Lisa Strycker, William H. Polonsky, Andrew Ahmann, Grazia Aleppo, Nicholas B. Argento, Joseph Henske, Sarah Kim, Elizabeth Stephens, Katherine Greenberg, Umesh Masharani; EMBARK: A Randomized, Controlled Trial Comparing Three Approaches to Reducing Diabetes Distress and Improving HbA_1c in Adults With Type 1 Diabetes. Diabetes Care 2024; dc232452. https://doi.org/10.2337/dc23-2452

If you are interested in providing a FREE Diabetes Distress program led by a team of experts for the health care professionals in your facility, Please download this Diabetes Distress Flyer for more info!

Want to Learn how to Implement This Approach in Your Practice? It’s easy – Join ReVive 5

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.

The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.

This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.

The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.

Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

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.

Accredited Training Program:

15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
A comprehensive set of assessment tools, educational materials, log sheets, and resources.

Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
Susan Guzman, PhD
Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Speakers Interviews – Learn more about the ReVive 5 Team

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Food Insecurity and Food Programs

by Christine Craig, MS, RD, CDCES

LT shared during a recent visit that over the past year, money to purchase food has become tight, and there are times when, by the end of the month, they do not have the resources to purchase more food.

In the US, 12.8% of individuals, 17 million households, and 16% of individuals with diabetes report experiencing food insecurity.¹

From 2021 to 2022, the prevalence significantly increased by 2.6% within the US population. Food insecurity has racial inequities and has a higher incidence in American or Alaska Native, Black, Hispanic, or multiracial households.¹ Children, older adults, individuals with increased diabetes complications, and individuals living in rural and urban areas are among the highest sub-populations at risk.

Food Insecurity Linked to Diabetes

Food insecurity is defined as “the limited or uncertain availability of nutritionally adequate and safe foods or the inability to acquire foods in socially accepted ways.”² Food insecurity and diabetes have a bi-directional relationship. Insecurity can lead to poor health, and poor health can reduce food access through loss of work/time at work, increased cost of medical care, and increased burden of disease.

Dietary intake and food access is strongly linked to health outcomes, and adults who experience food insecurity are two to three times more likely to develop type 2 diabetes.³ Reduced consumption of fruits, vegetables, and nutrient-dense foods increases the risk of insulin resistance and type 2 diabetes. For low-income individuals, studies³ have shown increased hospital ER visits and admissions for hypoglycemia during the last week of the month compared to earlier weeks. Financial constraints often force individuals to choose between purchasing medications and buying food.

The co-occurrence of diabetes and food insecurity is influenced by nutritional, mental health, and behavioral factors, according to the Weiser et al.² conceptual framework. At the individual level, interventions targeting food security and diabetes should focus on these interconnected pathways, especially considering the impact of competing demands on self-care prioritization. People living with diabetes and food insecurity often experience increased diabetes distress, depression, and higher A1c levels. Additional challenges such as cost-of-living, transportation, and medication costs further exacerbate these outcomes. Addressing behavioral barriers may involve providing transportation assistance, social work case management, and comprehensive medical care, and ensuring a review of medication costs. Mental health interventions could involve integrating food access programs with mental health screening and referral services in addition to problem-solving and coping strategies to reduce diabetes distress. The most helpful nutrition interventions aim to improve food accessibility, offer person-centered and budget-friendly nutrition counseling, and address policies and programs that reduce diabetes risk and complications.

Food Is Medicine Programs – Medically Tailored Meals

In 2023, the Department of Health and Human Services (HHS) developed the Food Is Medicine initiative, understanding that “access to nutritious food is critical to health and resilience.”³ The initiative focuses on developing strategies to reduce nutrition-related chronic disease and food insecurity while improving health and racial equity in the US.³ Food is Medicine can encompass many different programs, such as medically tailored meals, groceries, or produce prescription programs. Although A1C reduction results are mixed, each of these programs has shown an increase in fruit and vegetable consumption, food security, and quality of life measures.⁴

For individuals with diabetes, medically tailored meals result in the most evidence for improved diet quality, increased food security, improved diabetes self-management, and reduced hypoglycemic events.⁴ The programs are associated with lower health care utilization and cost for individuals with complex care needs. Medically tailored meals are designed by an RDN to meet the needs of the individual, are delivered directly to the home, and maybe a covered benefit if medical criteria are met. Seniors may access medically tailored and delivered programs through Medicare Advantage, Medicaid, or Area on Aging programs. Individuals who have chronic conditions and are post-hospital discharge have the highest likelihood of coverage. In California, Medi-Cal may provide up to three meals per day for twelve weeks for individuals with chronic health conditions (such as diabetes) who were recently discharged from a hospital or nursing home or require extensive care coordination. The Food is Medicine Coalition is a resource for additional information regarding Food is Medicine programs and can link individuals and providers to local participating agencies.

Food Insecurity on the Rise

Interventions begin with screening and knowing that more individuals with diabetes will experience food insecurity compared to just one year ago. We can utilize risk assessment tools, including the hunger vital signs, at least annually during our visits and, with patient collaboration, provide referrals to assistance programs. The most extensive federal food assistance programs include the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These programs are effective in increasing food security while also improving health outcomes. Reviewing eligibility and assisting in the coordination of services for Food Is Medicine programs, Nutrition Assistance Programs, and resources such as local food pantries, Meals on Wheels, or Area on Aging Agencies programs. www.Findhelp.org is a tool that can help individuals and providers find free or reduced- resources, from food to housing and more. Through assessment, understanding patient priority needs, and linking to resources, we can create a more supportive and therapeutic environment for individuals managing diabetes while experiencing food insecurity.

Links to Listed Resources:

Food is Medicine Coalition: https://fimcoalition.org
Hunger Vital Sign: https://fimcoalition.org
Supplemental Nutrition Assistance Program (SNAP): https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program
WIC: https://www.fns.usda.gov/wic
Local Food Pantries: https://www.feedingamerica.org/our-work/nutrition-health
Meals on Wheels: https://www.mealsonwheelsamerica.org/find-meals
Area on Aging Agencies: https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx
Find Help: www.findhelp.org

References:

Food Security and Nutrition Assistance downloaded on June 19th, 2024 from: https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/#:~:text=In%202022%2C%2012.8%20percent%20of,of%20a%20lack%20of%20resources
Weiser, Sheri & Palar, Kartika & Hatcher, Abigail & Young, Sera & Frongillo, Edward & Laraia, Barbara. (2015). Food Insecurity and Health: A Conceptual Framework. 10.1201/b18451-3.
Food is Medicine: A Project to Unify and Advance Collective Action. Downloaded on June 19th, 2024 from https://health.gov/our-work/nutrition-physical-activity/food-medicine.
Levi R, Bleich SN, Seligman HK. Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions. Diabetes Care. 2023 Sep 1;46(9):1599-1608. doi: 10.2337/dci23-0002. PMID: 37354336; PMCID: PMC10465985.
Wylie-Rosett J, DiMeglio LA. Strategies to Reduce Food Insecurity for People With Diabetes: A Call to Action. Diabetes Care. 2023 Feb 1;46(2):245-248. doi: 10.2337/dci22-0058. PMID: 36701599; PMCID: PMC9887607.

3 Ways Companion Pets Can Support People with Diabetes

For people living with diabetes, a companion pet may support their diabetes self-management and improve their quality of life.

Caring for our pets can bring a sense of joy, love, and companionship. It can also help us maintain a routine as we care for the well-being of our animals and thereby ourselves. Pets are an important part of the Diabetes Education Services work environment. You might hear Muffin and Biscuit wrestling in the background if you call Bryanna by phone. Those cute rescue felines are busy making mischief and keep Bryanna hopping. Or the barks of Freya and Sadie while talking with Brent. If you are watching a webinar with Coach Beverly, you will see her constant companion and Chiweenie, Choochi, napping on the comfy chair in the background. Choochi reminds Coach Beverly to take walks in the nearby field and to take a break from her treadmill desk.

Here are a few ways animals can support people living with diabetes.

Structure & Routine

Animals like a routine and need structure. Many know when their feeding time or play/exercise time is and will alert you to when those times are coming up. A pet’s routine can also be used by people living with diabetes to schedule their own meal times, medication schedules, and times for exercise. In fact, 47% of pet owners surveyed said that their pets keep them more active.

The American Hearth Association has this great handout for ways pets can motivate us to be more active.

Isolation & Loneliness

A study published by BMC Public Health that assessed the relationship between loneliness and blood glucose control in diabetes found that “systolic blood pressure was significantly correlated with loneliness in patients with diabetes.”

For people living with diabetes, pets can provide company, love, and nonhuman social support. Having animals can also connect us with others, such as going to the park with your dog, riding horses with others, or joining a pet group on social media.

Stress Reduction & Mood

Last year, the American Heart Association conducted a survey for their Healthy Bond for Life program which showed that “95% of pet parents rely on their pets for stress relief.” For those who experience diabetes distress, spending time petting an animal, watching them play, and snuggling up with them may help in times of stress.

Animal-assisted interventions have also been shown to have positive outcomes for those experiencing depression, PTSD, and anxiety.

How to Keep You and Your Pet Healthy

While there are many benefits to owning a pet, it is important to be aware of how to keep you and your pet safe. The CDC’s “Healthy Pets, Healthy People” hub has helpful information and resources on pet safety.

Unlock insights for managing diabetes distress with the experts!

Join us live on June 17 & 24, 2024 for our

ReVive 5 Diabetes Training Program:

The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.

This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.

The first session is team-taught by experts in the field of diabetes distress and effective communication approaches. Dr. Larry Fisher kicks off the program by describing the difference between depression and distress and interpreting Diabetes Distress screening results. Dr. Susan Guzman uses a case study approach and step-by-step communication strategies to address responses from the Diabetes Distress screening tool. This session includes an abundance of evidence-based approaches that you can apply in your clinical setting.

Coach Beverly leads the second session. During this three-hour program, Beverly describes insulin dosing strategies, meter and sensor data interpretation, and common issues encountered by people using diabetes technology. Case studies include tools to help individuals discover what changes are needed to get glucose to target, coupled with the communication skills discussed in the first session. In conclusion, the team of instructors review a case study that pulls together all the ReVive 5 elements.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

ReVive 5 Program PDF Flyer

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.

Accredited Training Program:

15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
A comprehensive set of assessment tools, educational materials, log sheets, and resources.

Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
Susan Guzman, PhD
Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Speakers Interviews – Learn more about the ReVive 5 Team

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Question of the Week | What is the cause of this emergency room visit?

LS is a 29-year-old who arrives in the emergency room with known history of type 2 diabetes. BMI is 23.9 and they are on basal insulin therapy and an oral medication to help “clear extra sugar”. On admission, their blood glucose is 189, pH is 7.2 and LS has 3+ betahydroxybyturate.

What is the most likely cause of these lab results?

LS is omitting insulin to lose weight.
There is a lab error in the glucose reading.
LS is taking a SGLT-2 Inhibitor.
New onset of cardiorenal syndrome.

Click Here to Test your Knowledge

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Join us live on June 13th at 11:30 am PST for our

Hospitals & Hyperglycemia

Level 2 Standards of Care Intensive

Research demonstrates the importance of glucose control during hospitalization to improve outcomes not only in the inpatient setting but after discharge. This course reviews the evidence that supports inpatient glucose control & outlines practical strategies to achieve targets in the inpatient setting. We incorporate the latest American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes & provide links to resources & inpatient management templates.

Objectives:

Describe the impact of hyperglycemia in the hospital setting.
Discuss the importance of inpatient glucose control.
List three strategies to get glucose to the goal in the hospital setting.

Learning Outcome:

The diabetes care team will gain insights and knowledge of special considerations, individualized goals, and standards for inpatients with diabetes that they can include in their practice.

Target Audience:

This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.

CDR Performance Indicators:

9.6.7
9.6.8
10.3.1

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.

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Rationale of the Week | Are statins indicated for Peds with Diabetes?

For last week’s practice question, we quizzed participants on when to start statin therapy for pediatrics with diabetes. 50% 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: Based on the ADA Standards, in addition to dietary intervention, lifestyle and glucose management, when is it indicated to consider starting statin therapy for pediatrics with diabetes?

Answer Choices:

When LDL is greater than 100 with a BMI of 25 or more.
After age 10, if LDL is still greater than 130 at 6 months.
Only if LDL and triglycerides are greater than 90^thpercentile.
Statins are only indicated for individuals 18 years and older.

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. 11.84% chose this answer. “When LDL is greater than 100 with a BMI of 25 or more.” This is a tempting answer. However, according to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.

Answer 2 is correct. 50% of you chose this answer. “After the age of 10 if LDL is 130 or greater.” Great job, this is the BEST answer. According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.

Answer 3 is incorrect. About 15.13% of respondents chose this. “Only if LDL and triglycerides are greater than 90^thpercentile.” According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.

Finally, Answer 4 is incorrect. 23.03% chose this answer. “Statins are only indicated for individuals 18 years and older.” According to ADA Standards, if after 6 months of intensive lifestyle intervention, the LDL is still greater than 130mg/dL and the child is 10 years or older, statin therapy is indicated to prevent cardiovascular complications.

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?

Join us live on May 30th at 11:30 PST for our

From Tots to Teens

Level 2 Standards of Care Intensive

This course includes updated goals & guidelines for children living with type 1 or type 2 diabetes. This course discusses the special issues diabetes educators need to be aware of when working with children with diabetes & their families. We discuss the clinical presentation of diabetes, goals of care, & normal growth & development through the early years through adolescence. Strategies to prevent acute & long-term complications are included with an emphasis on positive coping for families & children with diabetes.

Objectives:

Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes.
State Strategies to prevent acute and chronic complications.
Discuss the importance of positive psychosocial adjustment & resources.

Learning Outcome:

Attendees will have comprehensive knowledge of special considerations, individualized goals and standards for children with diabetes to include in their practice.

Target Audience:

CDR Performance Indicators:

9.6.7
9.6.8
10.3.1

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.

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Question of the Week | KR is on Metformin & 4 Weeks Pregnant. Best action?

KR has polycystic ovary syndrome and takes metformin 850mg twice daily. KR just discovered they are 4 weeks pregnant. Fasting glucose is 103 mg/dl.

According to ADA Guidelines, if prediabetes diagnosis is confirmed, what is the next step?

Continue metformin through first trimester.
Start basal insulin, stop metformin.
Add human basal bolus insulin.
Stop metformin, start sulfonylurea.

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Pregnancy & Diabetes

Level 2 Standards of Care Intensive

Pregnancy with diabetes is confronted with a variety of issues that require special attention, education, & understanding. This course reviews those special needs while focusing on Gestational Diabetes & Pre-Existing Diabetes. Included are the most recent diagnostic criteria, management goals, & prevention of complications during pregnancy. This is a helpful review for Certification Exams & those who want more information on people who are pregnant & live with diabetes.

Objectives:

List three issues that affect pregnancy with diabetes.
Describe the unique attributes of pre-existing diabetes in pregnancy & gestational diabetes.
State the diagnostic criteria & management goals for gestational diabetes.
Potential short-term & long-term complications of fetal exposure to hypoglycemia.
Prevention measures to keep mother & baby healthy.

Learning Outcome:

Participants will gain knowledge of special considerations, individualized goals, and standards for people experiencing diabetes during pregnancy to improve outcomes.

Target Audience:

CDR Performance Indicators:

9.6.7
9.6.8
10.3.1

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working diabetes specialist and a nationally recognized diabetes expert.

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Rationale of the Week | Best treatment for Hypoglycemia with Gastroparesis

For last week’s practice question, we quizzed participants on how to treat hypoglycemia while dealing with gastroparesis. 73% 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: JR has type 1 diabetes and was recently diagnosed with gastroparesis. JR is a runner and has not been able to exercise recently due to nausea, vomiting, bloating, and intestinal pain. They experience hypoglycemia about 3 times a week.

Based on this information, what is the best treatment for hypoglycemia?

Answer Choices:

Glucose tabs or gels.
Skittles or gummies.
High carb, low fiber snack bar.
Peanut butter crackers.

Getting to the Best Answer

Answer 1 is correct. 73.02% chose this answer. “Glucose tabs or gels.” Great job! Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Fast absorption of sugar from glucose tabs and gels begins in the mouth, to quickly raise blood sugar levels.

Answer 2 is incorrect. 3.72% of you chose this answer. “Skittles or gummies.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Gummies and skittles are more challenging to chew and need to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that the ability to chew can be impaired when someone is experiencing significant hypoglycemia. Glucose tabs and gel, are quickly absorbed and require minimal chewing and are the best choice.

Answer 3 is incorrect. About 14.70% of respondents chose this. “High carb, low fiber snack bar.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. A snack bar, even though it is low fiber, is more challenging to chew and needs to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that the ability to chew can be impaired when someone is experiencing significant hypoglycemia. Glucose tabs and gel, are quickly absorbed and require minimal chewing and are the best choice.

Finally, Answer 4 is incorrect. 8.56% chose this answer. “Peanut butter crackers.” Since JR has gastroparesis with slowed gastric emptying and delayed absorption of nutrients, we need to provide a fast acting carb that can instantly raise blood sugar. Peanut butter crackers are more challenging to chew and need to be broken down in the stomach, which would delay the blood sugar from increasing to a safe level. Another consideration is that peanut butter is a protein and fat combination food that would delay the absorption of the carbs from the crackers. Glucose tabs and gel, are quickly absorbed and would be the best choice!

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

Unlock insights for managing diabetes distress with the experts!

Join us live on June 17th & 24th, 2024 for our

ReVive 5 Diabetes Training Program:

The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.

This two-session training provides the essential steps to address diabetes distress combined with an innovative approach to helping people make sense of their glucose data.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

ReVive 5 Program PDF Flyer

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.

Accredited Training Program:

15+ CEs – Includes the 7-hour ReVive 5 Training Program, Certificate, and 5 FREE bonus courses to supplement content.
A comprehensive set of assessment tools, educational materials, log sheets, and resources.

Team of Experts:
ReVive 5 is taught by a team of 3 Interdisciplinary Experts:

Lawrence Fisher, Ph.D., ABPP, Professor Emeritus, UCSF
Susan Guzman, PhD
Beverly Thomassian, RN, MPH, CDCES, BC-ADM

Speakers Interviews – Learn more about the ReVive 5 Team

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Once Weekly Insulin Not FDA Approved due to Safety Issues

How would people living with type 1 diabetes benefit from once weekly insulin?

ONWARDS 6 Study Results – Using icodec for people living with Type 1

What is Insulin icodec?

Embark Trial Reveals Results – Spoiler Alert

The results of the EMBARK Trial are in! Spoiler Alert: These findings will change your practice approach.

First, let’s start with some background information.

Which Intervention Worked Best?

Results: TunedIn, an emotion-focused program, had the most consistent overall benefits when considering both Diabetes Distress and A1C (see infographic below).

We can incorporate three main approaches underlying this study into our clinical practice (from Embark Trial Article).

As a result of the Embark training and the Study results, I have finally given myself permission to make addressing the emotional aspects of diabetes a priority. ~Coach Beverly

(image from Embark Trial Study).

Embark Trial Study

Want to Learn how to Implement This Approach in Your Practice? It’s easy – Join ReVive 5

The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

Speakers Interviews – Learn more about the ReVive 5 Team

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

Food Insecurity and Food Programs

In the US, 12.8% of individuals, 17 million households, and 16% of individuals with diabetes report experiencing food insecurity.1

Food Insecurity Linked to Diabetes

Food Is Medicine Programs – Medically Tailored Meals

Food Insecurity on the Rise

Links to Listed Resources:

References:

3 Ways Companion Pets Can Support People with Diabetes

Isolation & Loneliness

Stress Reduction & Mood

How to Keep You and Your Pet Healthy

Unlock insights for managing diabetes distress with the experts!

Join us live on June 17 & 24, 2024 for our

ReVive 5 Diabetes Training Program:

The 2024 ADA Standards of Care now recommends annual screening for diabetes distress. If you are wondering how to screen for distress and tailor education based on the results, we encourage you to join this unique training program.

“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.

Speakers Interviews – Learn more about the ReVive 5 Team

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

Question of the Week | What is the cause of this emergency room visit?

Want to learn more about this question?

Join us live on June 13th at 11:30 am PST for our

Hospitals & Hyperglycemia

Level 2 Standards of Care Intensive

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Rationale of the Week | Are statins indicated for Peds with Diabetes?

Getting to the Best Answer

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Join us live on May 30th at 11:30 PST for our

From Tots to Teens

Level 2 Standards of Care Intensive

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Recent Blog Bytes

Question of the Week | KR is on Metformin & 4 Weeks Pregnant. Best action?

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Join us live on June 11th at 11:30 am PST for our

Pregnancy & Diabetes

Level 2 Standards of Care Intensive

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In the US, 12.8% of individuals, 17 million households, and 16% of individuals with diabetes report experiencing food insecurity.¹