Why Actos May Be Reemerging in the Diabetes Landscape
By: Beverly Thomassian
In the ever-evolving world of diabetes care, medications come in and out of favor based on new research, shifting safety data, and individual needs. Pioglitazone (Actos), once a go-to medication for improving insulin sensitivity, fell out of favor in the early 2010s due to concerns about bladder potential side effects and newer medications.
Now, pioglitazone is gaining renewed interest, especially for individuals with increased cardiovascular risk and steatosis, who may benefit from its unique profile. Even though pioglitazone only lowers A1C by 0.5 – 1.0%, this medication’s properties compel us to consider reintroducing it into the medical management of diabetes, especially in the presence of liver and heart disease. Plus, as a generic medication, its price tag of less than $5.00 a month makes it affordable for most people.
Potent Insulin Sensitizer
Pioglitazone is one of the thiazolidinedione (TZD) class of medications that work by enhancing insulin sensitivity, primarily through activation of PPAR-γ receptors in adipose and muscle tissue.
In a recent podcast, Banting Award Recipient, Dr. Ralph DeFronzo, provides an Insulin Resistance Master Class. He notes that pioglitazone, an insulin-sensitizing medication, improves cardiometabolic health, in part, by shifting fat distribution from visceral to subcutaneous areas. This redistribution of fat, may be associated with some weight gain. But, Dr. DeFronzo explains that this weight gain is actually a sign that the pioglitazone is working to improve insulin sensitivity. Compared to other oral agents, pioglitazone remains one of the most effective insulin sensitizers, especially useful in those with significant insulin resistance.
Why the Renewed Interest?
1. Cardiovascular Benefits – Decrease stroke and MI
The IRIS trial demonstrated that pioglitazone reduced the risk of stroke and myocardial infarction in insulin-resistant patients with a history of cerebrovascular events (Kernan et al., 2016). This benefit is being re-evaluated in the context of cardiometabolic risk, especially in people with atherosclerotic disease or metabolic syndrome.
The ADA Standard #3 states, “In people with a history of stroke and evidence of insulin resistance and prediabetes, pioglitazone may be considered to lower the risk of stroke or myocardial infarction. However, this benefit needs to be balanced with the increased risk of weight gain, edema, and fractures. Lower doses may mitigate the risk of adverse effects but may be less effective.”
2. Role in MASLD and MASH
Pioglitazone has shown promise in improving liver histology in people with metabolic-associated steatohepatitis (MASH), making it one of the few medications with such benefits (Cusi et al., 2017). Studies demonstrate it improves hepatic insulin sensitivity, reduces liver fat, and may slow fibrosis progression.
The ADA Standards of Care #4, include recommendations to start pioglitazone and GLP-1’s for individuals with diabetes and steatosis to prevent progression and slow fibrosis. “In phase 2 clinical trials, pioglitazone and some GLP-1 RAs have been shown to be potentially effective to treat steatohepatitis and to slow fibrosis progression. They may also decrease CVD, which is the number one cause of death in people with type 2 diabetes and MASLD.
3. Re-Evaluating Safety Concerns
Initial concerns about the risk of bladder cancer stemmed from observational studies; however, more recent analyses suggest that the risk is low or not statistically significant (Lewis et al., 2015). Furthermore, thoughtful prescribing—avoiding use in individuals with heart failure or active bladder cancer risk—helps mitigate potential harm. In addition, this medication is not recommended for those at risk of falls and fractures.
Comparative Benefits of Diabetes Medications
Here is a visual summary comparing the relative effects of pioglitazone versus other common medications:
Clinical Considerations
When considering pioglitazone (Actos), carefully assess:
- Cardiovascular history
- benefit for those with insulin resistance
- caution in heart failure
- Liver function and history of MASLD/MASH – recommended
- Bladder cancer history – avoid
- Fracture Risk – avoid
Pioglitazone may also be especially helpful in combination with agents like metformin or GLP-1 receptor agonists, balancing out each other’s side effects and mechanisms of action.
Conclusion
Pioglitazone (Actos) may never regain its former status as a front-line diabetes treatment, but it has a clear and valuable role in today’s therapeutic landscape. For select individuals—especially those with insulin resistance, cardiovascular risk, or liver disease—pioglitazone offers an underutilized tool backed by strong evidence and decades of experience.
In diabetes care, what’s old can be new again—especially when paired with clinical wisdom and person-centered decision-making.
📚 References
Want to learn more about ADA Standards?
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Question of the Week | Sleep and ADA Recommendations
A 62-year-old with type 1 diabetes presents for their follow-up visit. They report struggling with fatigue, poor sleep quality, and difficulty with glucose management despite taking medications as prescribed. Upon review, you find their A1C is 7.6%, and their average nightly sleep duration is 4.5-6 hours per night.
Based on the 2025 ADA Standards of Care, which of the following interventions would be the most appropriate next step to address sleep and glucose management?
- Refer to a sleep study to evaluate for obstructive sleep apnea and adjust the medication regimen.
- Encourage engagement in vigorous evening exercise to promote better sleep.
- Screen sleep health and develop a plan to create consistent sleep routines and habits.
- Advise taking over-the-counter melatonin supplements to improve sleep quality.
Want to learn more about this question?
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Rediscovering Walking – From Rucking to Kicking Up Intensity
Walking is often recognized as the most accessible and underrated form of exercise. While some may argue in favor of high-intensity cardio or resistance training, a growing body of evidence suggests that walking offers significant benefits—especially when approached with intention and consistency.
According to Dr. Elroy Aguiar, an assistant professor of exercise science at The University of Alabama, walking remains one of the most beneficial forms of movement due to its low barriers to entry—minimal cost, equipment, or skill required. “That’s why we say it’s the best,” Dr. Aguiar notes. And yet, despite this accessibility, many individuals struggle to find time to incorporate walking into their busy, sedentary lives.
🚶♂️ Cadence Matters: Walking with Intensity
Not all walking provides the same health return. The intensity, particularly cadence (steps per minute), plays a crucial role in determining health outcomes.
🕒 100 steps per minute is considered moderate intensity
⚡ 130 steps per minute qualifies as vigorous intensity
Dr. Aguiar’s research, published in the British Journal of Sports Medicine, indicates that health benefits from walking begin to accumulate at moderate or higher intensities. Most people naturally walk at a pace of 110–115 steps per minute when moving briskly. Increasing cadence just slightly can shift the effort from moderate to vigorous, maximizing the health payoff in a shorter time span.
🎒 Add Intensity with Rucking
For those looking to increase the challenge of walking, rucking—walking with a weighted backpack—offers a practical solution.
Adding resistance increases oxygen demand, raises heart rate, and enhances caloric burn without requiring a change in pace or duration. According to Dr. Aguiar, this method can also improve lower body strength and bone density, particularly with consistent practice over time.
While it won’t replace traditional strength training, rucking offers an accessible way to gain some muscular benefits while walking. A light weight to start, gradually increased, can help prevent injury and support adaptation.
⏱️ One Minute Can Make a Difference
A 2024 study published in the Scandinavian Journal of Medicine and Science in Sports found that both the quantity and intensity of physical activity are associated with better health outcomes. Remarkably, even one minute of higher-intensity activity per day was linked to a lower likelihood of having metabolic syndrome—a cluster of risk factors including visceral adiposity, high blood pressure, high blood sugar, low HDL cholesterol, and elevated triglycerides.
Dr. Aguiar explains that an individual’s most intense one-minute activity across the day can serve as a strong indicator of metabolic health. Even brief, high-intensity bursts of activity may help reduce risk for diabetes, hypertension, and cardiovascular disease.
🍽️ Walking After Meals: A Simple Strategy for Blood Glucose Improvement
Another practical strategy supported by research is post-meal walking. A 15-minute walk after meals can help blunt spikes in blood glucose, particularly in older adults at risk for glucose intolerance.
When muscles are active, they draw glucose from the bloodstream to use for energy, thereby reducing blood sugar levels and easing the demand on insulin. Over time, this can help prevent insulin resistance, a precursor to Type 2 diabetes.
Dr. Aguiar notes that consistent post-meal movement can reduce the workload on the pancreas and enhance the muscles’ ability to absorb and use glucose. This daily practice may offer long-term protection against metabolic syndrome, hypertension, and diabetes.
📉 Step Count and Longevity
Large-scale studies have shown clear associations between step count and mortality risk. A 2023 meta-analysis published in the European Journal of Preventive Cardiology found:
- 2,337 steps/day: lower cardiovascular mortality
- 3,867 steps/day: lower all-cause mortality
- Each additional 1,000 steps: 15% reduction in all-cause mortality
- Each additional 500 steps: 7% reduction in cardiovascular mortality
Additionally, a study by the University of Granada concluded that while more steps bring more benefits, the majority of cardiovascular protection appears to occur around 7,000 steps/day. The popular goal of 10,000 steps per day, while not evidence-based, remains a useful motivational benchmark.
💡 Who Benefits the Most?
For elite athletes, walking may offer limited fitness returns. However, for individuals who are sedentary or new to exercise, walking provides a low-impact, effective entry point to better health.
Some key benefits of walking for the general population include:
- Improved cardiovascular health
- Strengthened muscles and joints
- Support for bone density
- Increased daily caloric expenditure
- Reduced risk of chronic diseases
Walking is especially valuable for individuals managing or at risk for Type 2 diabetes, obesity, hypertension, and metabolic syndrome.
🔟 Key Takeaways
- Cadence matters – 100 steps per minute = moderate; 130+ = vigorous
- Even one minute of high-intensity movement can improve metabolic markers
- 15-minute walks after meals can significantly lower blood glucose
- Rucking adds intensity, strength, and calorie burn to walking
- Walking is linked to lower mortality from all causes and cardiovascular disease
- Most benefits occur by 7,000 steps/day, but more is better
- Walking is an entry point to fitness, particularly for the sedentary
- The practice supports muscle and bone health
- It requires no equipment and is nearly universally accessible
Walking delivers significant, sustainable health benefits with minimal risk
📝 Final Thoughts
Walking is a powerful yet underappreciated form of movement. Whether used to regulate blood sugar, reduce cardiovascular risk, or improve mental clarity, walking remains one of the most effective and inclusive health strategies available.
For anyone looking to improve overall health without the barriers of cost, complexity, or time—walking offers a proven path forward.
📚 References
- Aguiar, E. J., et al. (2021). Walking cadence (steps/min) and intensity in 21–40-year-olds: CADENCE-adults. British Journal of Sports Medicine.
- DiPietro, L., et al. (2013). Benefits of Postmeal Walking on Glycemic Control in Older Adults at Risk for Impaired Glucose Tolerance. Diabetes Care, 36(10), 3262–3268.
- European Journal of Preventive Cardiology (2023). Daily step count and all-cause and cardiovascular mortality: a dose–response meta-analysis.
- University of Granada Study (2023). Step count thresholds for cardiovascular benefit: optimal versus traditional targets. European Journal of Preventive Cardiology.
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Celebrating Earth Day: How Native Plants Support Wildlife and Our Well-Being
In honor of Earth Day, April 22, 2025, we’re shining a light on the power of native plants in creating vibrant, resilient ecosystems—for wildlife and for people.
Native plants—those that have evolved naturally in a specific region—play a crucial role in supporting local pollinators, birds, butterflies, and other wildlife. These plants provide essential food, pollen, and shelter that many species rely on for survival. And while the benefits to the environment are clear, cultivating native plants also boosts human well-being. Thriving ecosystems support cleaner air and water, increased biodiversity, and create opportunities for people to reconnect with nature.
🌻 A Journey Toward Native Planting
When Coach Beverly moved into her home 26 years ago, she planted what many of us do—flowers and grasses that looked appealing and could withstand local heat. With an acre of land surrounding her home and office, she had space to experiment, adding a wide variety of foliage and trees for beauty and shade.
But like many at that time, she wasn’t yet aware of the importance of native plants—or how their presence (or absence) affects the animals, insects, and birds that share our space.
Over time, as she learned more about habitat loss and the plight of pollinators, she began to rethink her approach. Through research, visits to a nearby native nursery, and the help of trusted websites, she and her husband began the transformation: reshaping their land into a space that supports bees, butterflies, frogs, birds, lizards, and more. Today, their yard is not only beautiful but also an oasis for wildlife—and a model of sustainable gardening.
💧 Water: A Simple Yet Powerful Addition
In addition to plants, providing a water source can be a game-changer for thirsty pollinators and wildlife. Whether it’s a birdbath, a shallow dish, or a small pond, water invites life into any garden.
Last year, Coach Beverly dug a small frog pond. Within weeks, frogs, toads, and birds made themselves at home. A year later, the pond teems with tadpoles, mosquito fish, dragonflies, water beetles, and countless other tiny creatures.
The pond has become a source of daily joy and fascination for family and visitors alike—a reminder of how deeply nature nurtures our spirits. It has also been a powerful tool for stress relief and mental well-being.
🌿 Nature as Therapy
For those managing diabetes, chronic conditions, or everyday stress, spending time in nature and caring for living things can be deeply therapeutic. And it doesn’t have to be complicated.
Start small:
- Plant a few herbs or flowers in containers
- Scatter wildflower seeds on a patch of earth
- Nurture a potted tomato plant on a sunny windowsill
For the more adventurous, creating a native plant garden is a wonderful excuse to get outdoors, move your body, and take pride in a growing, living space. There’s something special about tasting a sun-warmed tomato that’s been nurtured from seed to fruit.
🌸 Not Sure What’s Native in Your Area?
A great place to start is the article Audubon – 20 Common Types of Native Plants, which outlines beneficial plants found across the U.S. To make it local, cross-reference with your zip code using tools like the Native Plant Finder – NWF by the National Wildlife Federation.
For example, in Chico, California, the California Christmas-Berry is drought-tolerant and a favorite food source for local birds.
🌳 Here are a few native plant ideas to consider:
- Trees: Oak, Pine, Dogwood, Willow
- Colorful blooms: Coneflower, Sunflower
- Edible treats for people and birds: Blueberries, Elderberries, Serviceberries
Need help sourcing plants? The Plant Native website offers a helpful directory of native nurseries throughout the U.S.
🌱 Every Action Counts
Many people feel overwhelmed or discouraged by the state of the planet. But there is also a growing awareness of our power to make change—and hope rooted in action.
Whether it’s planting a single native shrub, providing a bowl of water, or simply observing and appreciating the life around us, every effort makes a difference.
Visit www.earthday.org and Project Regeneration for more ideas and inspiration on how to help the Earth thrive.
💚 Final Thoughts
Each person has the ability to nurture the planet and themselves, starting right at home. Native plants are a simple, beautiful way to support both biodiversity and human well-being.
So this Earth Day, consider taking that first step. Plant something. Provide water. Let nature in. And know that even the smallest actions ripple outward in meaningful ways.
🌎 Happy Earth Day from Coach Beverly and the Diabetes Education Services team.
Earth Day Resource Page
🔹 Educational & Advocacy Resources
- EarthDay.org
- The official Earth Day site with toolkits, event listings, campaigns, and actions for climate and environmental justice.
- Explore initiatives like The Great Global Cleanup, Climate Literacy, and Canopy Project.
- EPA: Environmental Protection Agency
- U.S. government resource for Earth Day activities, environmental data, and sustainability tips.
- Great for educators, students, and community organizers.
🔹 Native Plant and Wildlife Support
- National Wildlife Federation – Native Plant Finder
- Enter a zip code to find plants native to your region that support pollinators and birds.
- Audubon Society – Plants for Birds
- Offers native plant lists by zip code, along with guidance on how to create a bird-friendly yard or balcony.
- Plant Native
- Directory of native plant nurseries across the U.S., plus regional planting guides.
🔹 Local Action & Community Involvement
- VolunteerMatch – Environmental Opportunities
- Search for local Earth Day cleanups, planting projects, and sustainability initiatives.
- The Great Global Cleanup
- A global effort to remove billions of pieces of trash from neighborhoods, beaches, rivers, and parks.
🔹 Resources for Teachers & Families
- National Geographic Education – Earth Day Resources
- Lesson plans, activities, and videos for classrooms and curious learners.
- NASA Climate Kids
- Fun, educational site for children that explains climate science with games, activities, and stories.
🔹 Sustainable Living Guides
- Offers practical advice on reducing personal environmental impact across home energy, food, waste, and travel.
- Interactive platform that turns sustainability efforts into group challenges for schools, businesses, and individuals.
✅ Bonus Tip:
Host a Local Event!
Use EarthDay.org’s event map to find or promote cleanups, workshops, or plantings in your area.
Rationale of the Week | What happens when people stop taking GLP /GIPs?
For last week’s practice question, we quizzed participants on what happens when people stop taking GLP /GIPs. 81% 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:
About 30% of people with diabetes started on GLP-1’s stop taking this medication before completing a year of therapy.
According to ADA Standards, what results from sudden discontinuation of GLP-1s /GIP like semaglutide and tirzepatide?
Answer Choices:
- People maintain their weight loss for at least a year.
- People regain at least one-half of their weight loss within a year.
- People experience decreased nausea and less than 10% weight regain.
- People continue behaviors learned on medication with ongoing weight loss success.
Getting to the Best Answer
Answer 1 is incorrect. 4.71% chose this answer. “People maintain their weight loss for at least a year.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
Answer 2 is correct. 81.44% of you chose this answer. “People regain at least one-half of their weight loss within a year.” YES, this is the best answer! Great JOB. According to ADA Standards, “sudden discontinuation of semaglutide and tirzepatide results in regain of one-half to two-thirds of the weight loss within 1 year. Consider trying lowest effective dose, using intermittent therapy, or stopping medication followed by close weight monitoring. This information is helpful for our clinical practice as we navigate the best approach to utilizing GLP-1 /GIP Therapy.
Answer 3 is incorrect. About 9.28% of respondents chose this. “People experience decreased nausea and less than 10% weight regain.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
Finally, Answer 4 is incorrect. 4.57% chose this answer. “People continue behaviors learned on medication with ongoing weight loss success.” According to the ADA Standards, people regain 50 to 70% of the weight lost after this gut hormone replacement therapy is stopped.
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!
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Question of the Week | Based on ADA Standards, what is next med addition?
JR has type 2 diabetes and takes Metformin 1000mg BID and sitagliptin (Januvia), A1C 8.1%. GFR 47, UACR 158mg/g. Recent diagnosis of congestive heart failure. These are the medications their insurance covers.
Of the following medications, which addition would most benefit JR?
- glipizide (Glucotrol)
- pioglitazone (Actos)
- semaglutide (Ozempic)
- dapagliflozin (Farxiga)
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
Rationale of the Week | 2025 ADA Standards: Key Nutrition Behaviors for Individuals with Diabetes
For last week’s practice question, we quizzed participants on. 79% 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:
According to the 2025 ADA Standards of Care, which of the following nutrition behaviors are strongly encouraged for individuals with diabetes?
Answer Choices:
- Incorporate onions, garlic, celery, carrots and other vegetables for a base of homemade
foods. - Use herbs and spices to season foods instead of salt containing preparations.
- Water should be the primary beverage of choice.
- Include family or roommate in meal preparation.
- All of the above
Getting to the Best Answer
Answer 1 is incorrect. 1.7% chose this answer, ” Incorporate onions, garlic, celery, carrots and other vegetables for a base of homemade foods.” Although this answer is true, it is not the best answer. Incorporate onions, garlic, celery, carrots, and other vegetables for a base of homemade foods. These foods can serve as a base to many dishes and incorporates flavor, fiber, vitamins, and minerals while encouraging vegetable consumption.
Answer 2 is incorrect. 4% of you chose this answer, “Use herbs and spices to season foods instead of salt containing preparations.” Although this answer is true, it is not the best answer. 90% of people in the US exceed the daily recommended limits for sodium. Reducing salt intake is important for heart health, managing blood pressure and meeting dietary guidelines. Herbs and spices not only enhance flavor and may provide additional health benefits.
Answer 3 is incorrect. About 12% of respondents chose this, “Water should be the primary beverage of choice.” Although this answer is true, it is not the best answer. The 2025 ADA Standards of Care have emphasized water as the primary beverage of choice. Alternatives to plain water can include no calorie alternatives. Suggestions to add lemon, lime or cucumber to water, choose sparkling no calorie beverages and no-calorie carbonated beverages are also encouraged.
Answer 4 is incorrect. 2% chose this answer, “Include family or roommate in meal preparation.” Although this answer is true, it is not the best answer. Engaging others in meal preparation can create a supportive environment, encourage healthier eating habits, and make cooking more enjoyable. Social support can be especially helpful in managing diabetes long-term.
Answer 5 is correct. 79% chose this answer, “All of the above.” The 2025 ADA Standards of Care encourages all the above nutrition behaviors.
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!
Ignite your passion & prepare for Diabetes Certification!
Join our Expert Team at our dynamic Virtual DiabetesEd Training Conference April 16-18th, 2025
Gain fresh insights, practical tools, and a deeper understanding of the latest in person-centered diabetes care. Our expert team brings the ADA Standards of Care to life—covering medications, behavior change, technology, and more! If you’re preparing for the CDCES or BC-ADM exam, this conference—paired with free bonus courses—serves as the ideal study companion!
With interactive co-teaching, we keep sessions engaging, relevant, and fun. Let’s learn and grow together!
Our expert team transforms complex diabetes science into clear, practical insights—keeping it real, engaging, and fun! The faculty includes:
- Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES
- Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
- Christine Craig, MS, RD, CDCES
- 3 Days: of critical information delivered by passionate speakers in an engaging and fun format!
- 11 Bonus Online Courses: As a course attendee, you automatically receive a bonus online course bundle of 11 online courses valued at over
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