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?
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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.
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Recent Blog Bytes
- Question of the Week | Lower Extremity Recommendation for JT?
- Rationale of the Week | What best describes the action of GLP-1 Receptor Agonists?
- Rybelsus Dosing Update & Single Dose Vial Tirzepatide (Zepbound)
- Question of the Week | Best example of Person-Centered Question?
- Rationale of the Week | What Helps Manage Gastroparesis in Type 1 Diabetes?
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!
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- 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
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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.
ReViVE 5 Diabetes Training Program:
Unlocking Hidden Barriers to Diabetes Management
June 17th & 24th, 2024
“ReVive 5” breathes new life into our relationship with diabetes, bringing a fresh perspective to both the person with diabetes and the provider.
The ReVive 5 program is built on sound research from the Embark Trial and will revolutionize your approach to diabetes self-management education.
We have reassembled the Embark training team and created a resource binder of fantastic tools that we are excited to share with you in our ReVive 5 Diabetes Training Program. You are invited to join us to learn a step-wise, proven approach to addressing hidden barriers to diabetes self-management and glucose management.
You don’t need to be mental health expert or diabetes technology wiz to join this training or to integrate these new strategies into your daily practice.
ReVive 5 uses an integrated, evidence-based approach that provides health care professionals with a realistic 5-step approach to addressing the whole person, starting with emotional distress and incorporating a unique, but integrated approach to problem-solving glucose management difficulties.
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 CDCES or BC-ADM Certification Exams.
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.
Join us to gain the confidence and learn the skills needed to support people with diabetes to move forward in their self-management and discover the expert within.
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
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 | Lower Extremity Recommendation for JT?
- Rationale of the Week | What best describes the action of GLP-1 Receptor Agonists?
- Rybelsus Dosing Update & Single Dose Vial Tirzepatide (Zepbound)
- Question of the Week | Best example of Person-Centered Question?
- Rationale of the Week | What Helps Manage Gastroparesis in Type 1 Diabetes?
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.
Diabetes Disparities in the Black Community
February is Black History Month, and we want to take this opportunity to recognize the significant impact of diabetes on Black communities.
According to the Centers for Disease Control and Prevention (CDC), Black Americans are approximately 60% more likely to be diagnosed with diabetes compared to non-Hispanic White Americans. In addition, Black individuals with diabetes are at increased risk of complications such as heart disease, stroke, kidney disease, and lower extremity amputations.
Social determinants of health play a significant role in the prevalence, management, and outcomes of diabetes among Black Americans. These determinants encompass various socio-economic, environmental, and cultural factors that influence health outcomes.
They also lead to an underrepresentation of culturally relevant healthcare for various communities, including Black Americans. Cultural beliefs, attitudes, and practices regarding health, diet, and exercise may influence diabetes prevention and management behaviors. If there is a lack of trust in the patient-provider relationship, it can exacerbate barriers to receiving care and decrease positive outcomes. According to a pilot study from 2019:
Trust in physicians depends on physicians’ appreciation of patients’ knowledge, beliefs, and attitudes and, for Black patients in particular, on patients’ perceived racism. The latter predicts lower rates of physician visits, medication adherence, and preventive care, which compromise glycemic control and increase the risk of progression of Diabetes Retinopathy to blindness.
Diabetes Educators have an opportunity to cultivate an environment of trust and address healthcare disparities by recognizing the intersection of race, socioeconomic status, and health. Additionally, practicing cultural humility to develop critical self-awareness of personal implicit or explicit values and behaviors that may contribute to health care disparities. Cultural humility acknowledges the role of power and privilege within the patient-provider dynamic and within the health care system itself. By taking a closer look at our own biases during interactions, we can start becoming more intentional and align with the individual’s needs and values when providing care.
Individual efforts will also need to be joined by community-based interventions, healthcare system reforms, policy changes, and targeted public health initiatives. However, by personally considering how we can address the social determinants of health and implement culturally relevant strategies within our clinics and hospitals, it is possible to reduce the burden of diabetes for the people we work with and improve health outcomes in Black communities.
Resources & Articles for further reading:
- Advancing Health Equity by the Centers for Disease Control and Prevention (CDC)
- Improving Equity and Access to Health Care: How Nontraditional Organizations Can Help Increase Clinical Trial Diversity by the American Diabetes Association (ADA)
- Trust and Glycemic Control in Black Patients With Diabetic Retinopathy: A Pilot Study
- Diabetes and African Americans
- Racial and Ethnic Disparities in the Management of Diabetic Feet Clayton EO, Njoku-Austin C, Scott DM, Cain JD, Hogan MV. Racial and Ethnic Disparities in the Management of Diabetic Feet. Curr Rev Musculoskelet Med. 2023 Nov;16(11):550-556. doi: 10.1007/s12178-023-09867-7. Epub 2023 Sep 21. Erratum in: Curr Rev Musculoskelet Med. 2024 Jan 25;: PMID: 37733148; PMCID: PMC10587034.
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 action to address sudden Hyperglycemia due to Cellulitis?
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?
- 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.
Click Here to Test your Knowledge
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.
Big Change to CDCES Exam – Less Test Questions & Different Outline starting in July
We are excited to announce the most significant change to the CDCES Exam in the past 30 years (besides moving to computer testing from scantrons). If you plan on taking the CDCES exam after June 30, 2024, there will be fewer total questions and an increased focus on diabetes care and interventions.
The Certification Board for Diabetes Care and Education (CBDCE) handbook states that only 175 questions are needed, instead of 200, to evaluate if an individual has adequate expertise and mastery of the test content.
If you are taking the test through June 30, you can expect the same number of questions, 200 multiple-choice questions, using the current CDCES test outline.
Starting July 1, there will only be 175 test questions based on an updated test outline.
Regardless of when you take the exam, certain things will remain the same.
There will still be 25 questions that are NOT counted in the final test score. These questions are scattered throughout the exam and allow for collection of meaningful statistics about new questions, but are
not used in the determination of individual examination scores.
In addition, this exam results are based on a “scaled score” to ensure that different exam versions are equally challenging. The CBDCE has made no mention of a decrease in the four hours to complete the exam, and certificants can still take the exam at a testing site or choose live remote proctoring.
With the current CDCES test outline, effective through June 30, 2024, here is how the counted 175 questions are divided by content (There are 200 questions, but only 175 count toward the final score)
- Assessment of the Diabetes Continuum – 59 questions
- Interventions for Diabetes Continuum – 88 questions
- Disease Management – 28 questions
For more details, please see the current CDCES Exam Content Outline | January – June 2024 page 21.
Starting July 1, 2024, the test outline will have significant changes. Here is how the counted 150 questions are divided by content (There are 175 questions, but only 150 count toward the final score)
- Assessment – 37 questions
- Care and Interventions – 105 questions
- Standards and Practices – 8 questions
For more details, please see the CDCES Exam Content Outline | July 1, 2024
A lot of the changes are under “Care and Education Interventions” sections on the exam content outline effective July 1, 2024. For complete eligibility and certification information, the 2024 Certification Examination for Diabetes Educators Handbook contains detailed instructions on applying, study resources, and exam content outlines.
Should I take the CDCES exam before or after the changes?
This is a great question, and Coach Beverly suggests carefully self-evaluating your testing style. If the thought of muscling through 200 questions seems overwhelming and question fatigue is an issue, consider taking the shorter version in July. However, as with any new exam, there may be some kinks to iron out, and there could be a slight delay in receiving test results in the first few months after the exam’s release, based on my experience. When there has been a test update in the past, the CBDCE took a few weeks to send the test results to test takers for a short time period.
Coach Beverly suggests basing your decision on your level of readiness. After reviewing the exam outline content, if you feel very familiar with the topics listed, plus you are scoring 80% or greater on practice exams, moving forward with the exam is a great choice. Keep in mind that the exam covers a wide breadth of information, from birth to death, plus during pregnancy, and addresses chronic and acute care in various settings. This means you will need to create a study plan that assesses knowledge gaps along with a plan to address those gaps.
Will Your Online University Courses Prepare Students for the Updated Exam Content?
Yes, absolutely. We carefully consider the exam content outlines coupled with Coach Beverly’s test-taking experience when updating our program content.
Our online course content is updated each year based on a review of the latest ADA Guidelines and the CBDCE’s exam content outline. If the ADA Standards include new or updated information that is listed in the exam outline, we plug in these new medications, MNT approaches, goals, screening guidelines etc. into the course content. A big chunk of the changes starting in July are under the “Care and Education Interventions” section. The good news is that our library of courses already focus on person-centered care and the interventions that are outlined in section II, in the Exam Content Outline | July 1, 2024.
Coach Beverly also retakes the exam every renewal cycle for her certification so she can have a student’s perspective on sitting for the exam while developing course content. We try to focus specifically on material that is relevant for the exam, considers the overall ADA Standards of Care and ultimately improves quality of care delivered to people living with diabetes.
Our goal is to provide evidence-based, clinically relevant content that will also prepare participants for exam success. We’ve got you covered.
Conflict of Interest clarification:
Our company Diabetes Education Services has no relationship with the CBDCE. All of the information posted in this blog is based on Coach Beverly’s careful review of the 2024 Certification Examination for Diabetes Educators Handbook.
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.
Meet Brent McMenomey – Customer Advocate and Brand Ambassador
To provide exceptional customer service as our company continues to grow, we are excited to introduce Brent McMenomey, the newest member of our team. Brent is a perfect fit for our Customer Advocate & Brand Ambassador position given his extensive background in customer service, graphic design, and marketing.
As your Customer Advocate, he will always be sure your questions are answered and your concerns addressed. He has decades of experience in troubleshooting issues, both service-related and technical, and is always happy to help!
Brent loves nature, as well as animal lover with 3 dogs (Freya, Sadie and Wesley), a few chickens and 15 finches. Brent also has a YouTube Channel dedicated to gardening and small home renovations called Visit Our Garden that he films and edits with his partner. Welcome Brent!
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.
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