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Rationale of the Week | What Do New ADA Standards Say About Development of Type 2?
For last week’s practice question, we quizzed participants on the new ADA Standards and the development of type 2 diabetes. 42.48% 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
According to the new 2026 ADA Standards, “type 2 diabetes is associated with insulin secretory defects related to” which of the following?
- BMI and activity level.
- Lifestyle and inflammation.
- Genetics and visceral adipose distribution.
- Epigenetics and metabolic stress.
Getting to the Best Answer
Answer A is incorrect: 14.85% chose this answer, “BMI and activity level.” This answer is incorrect but tempting. BMI level is used as a a screening tool for prediabetes and diabetes risk, but is not included as a factor contributing to secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.
Answer B is incorrect: 16.92% chose this answer, “Lifestyle and inflammation.” This juicy answer is incorrect. Lifestyle is not a direct factor related to insulin secretory defects, but inflammation is a contributor. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.
Answer C is incorrect: 25.75% chose this answer, “Genetics and visceral adipose distribution.” This answer is incorrect. Visceral adiposity is associated with an increased risk for diabetes, but does not contribute to insulin secretory defects. According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.
Answer D is correct: 42.48% chose this answer, “Epigenetics and metabolic stress.” This answer is correct, GREAT JOB! According to the ADA, there are four factors related to insulin secretory defects in type 2 diabetes. They include; genetics, epigenetics, metabolic stress and inflammation.
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!
Join Coach Bev!
Take a Deep Dive Into the 2026 ADA Standards
On January 29th, 2026 at 11:30 AM PST
Meds PocketCard Refresh for 2026!
Fresh updates. Clear comparisons. Even more clinical confidence.
You are going to love the latest updates to our Medication PocketCards—designed to help you make quick, informed decisions at the point of care.
GLP-1 & GIP Medications: Now Easier to Compare Than Ever
Our GLP-1 & GIP Meds PocketCard now includes two distinct versions—one for diabetes and one for weight management—so you can compare therapies at a glance.
Each version clearly outlines:
- Approved indications
- Medication action
- Efficacy
- Common side effects
This side-by-side approach makes it easier to individualize treatment decisions based on a person’s health profile, age, and comorbidities.
Oral Semaglutide for Weight Loss—Now Included
Big news in the GLP-1 world! Semaglutide is now available as an oral formulation for weight loss, and we’ve added it to the PocketCard.
- Rybelsus® remains the oral option approved for diabetes
- Oral semaglutide for weight loss is FDA-approved and included on the updated card
- Both formulations are approved to reduce cardiovascular risk
Just like Rybelsus, oral semaglutide for weight loss:
- Must be taken on an empty stomach
- With a small sip of water
- At least 30 minutes before food, beverages, or other medications
Good-Bye to Exenatide XR
It’s the end of an era. Exenatide XR (Bydureon®, Bcise®) has been discontinued.
The only remaining option is generic exenatide, administered twice daily—still available and noted on the updated PocketCard.
TZDs: A Farewell and a Comeback
We say goodbye to rosiglitazone and welcome a renewed appreciation for pioglitazone (Actos®).
Pioglitazone:
- Improves insulin resistance
- Lowers free fatty acids
- Is now indicated for hepatic steatosis or for individuals who have experienced a stroke.
Research led by Dr. Ralph DeFronzo demonstrates that pioglitazone can shift fat from visceral to subcutaneous depots, improving metabolic health and liver outcomes.
Clinical pearls included on the card:
- Start low (15 mg) and titrate slowly
- Monitor for fluid retention and weight gain
- Check ankles and assess heart failure risk
- Avoid in individuals with CHF or high fracture risk
Importantly, pioglitazone is also indicated for people with prediabetes or diabetes who have experienced a stroke, as it significantly reduces the risk of recurrent stroke.
DPP-4 Inhibitors: A Smaller Role
DPP-4 inhibitors continue to decline in use due to lower efficacy and higher cost, and both alogliptin and saxagliptin carry an increased risk of hospitalization for heart-failure .
That said, generic saxagliptin is once again available, so we’ve added it back to the PocketCard in the DPP-4 category—clearly labeled to support informed prescribing.
Learn More About Meds With Upcoming Courses
ADA Standards of Care Complete Review
Join us live on January 29th, 2026 at 11:30 AM PST!
Question of the Week | CS’s A1C Climbs After Experiencing Distress
CS is a 42-year-old with type 1 diabetes for just over 18 years. In the past year, their A1C changed from 7.4% to 9.1%, and weight increased by 20 pounds. Review of CGM data suggests missed insulin boluses more than 7 times per week, and discussion with CS reveals missed clinic visits due to feeling “burned out”. They score in the moderate range on the Diabetes Distress Scale.
Based on the ADA 2026 Standards of Care, which of the following is the most appropriate next step?
- Partner with CS to reduce missed boluses and reassess in 3 months.
- Simplify regimen to support current state of diabetes distress.
- Refer to a qualified behavioral health professional for evaluation and treatment.
- Recommend referral to MNT for a structured weight-loss program.
Level 2 | ADA Standards of Care Complete Review
2026 Recording Available On-Demand
Level 2 | Improving Care and Promoting Health
Join us live on February 10th, 2026 at 11:30 AM PST!
The Case for Professional Practice Groups in the Digital Age
If you’ve considered not renewing your professional practice group membership this year, you’re not alone. Membership in professional organizations has declined as many turn to social media and AI-driven platforms for information and connection. Still, I encourage you not to abandon professional membership in favor of options that may seem cheaper or more convenient.
In a noisy, chaotic landscape of information overload, professional practice groups remain a refuge from the storm. They offer a trusted alternative to clickbait, providing vetted expertise, meaningful connection, and true professional community.
No amount of viral TikTok videos or LinkedIn commentary can replace the depth of connection and sense of purpose that come from active engagement in a professional practice organization. And, here’s why.
What is a Professional Practice Group?
Professional practice groups, also known as professional practice organizations, are designed to advance a specific field by providing members with networking opportunities, professional development, and practice resources. In healthcare, these organizations may be tailored to the needs of a single discipline, such as the American Nurses Association, or span interdisciplinary areas of practice, like the Association of Diabetes Care and Education Specialists or the American Diabetes Association.
Some organizations focus primarily on education and credentialing, while others emphasize leadership development and community building. Still others center their work on advocacy related to patient care, access, and insurance coverage.
Who Actually Runs a Professional Practice Group?
At its core, most professional practice groups are founded and driven by their members, with membership dues supporting the administrative needs required to operate. As groups grow, they often engage professional management or organizational leadership teams to oversee day-to-day operations such as membership services, programming, finances, legal compliance, and other administrative functions.
Strategic direction and oversight typically remain the responsibility of an elected or appointed governing body. In some cases, professional organizations may choose to hire members, transitioning them from volunteer roles into paid staff positions.
As operating costs rise, often without corresponding increases in salaries or reimbursement, many professional practice groups partner with industry or government organizations for additional financial support. These partnerships can help keep membership dues, educational programming, and events accessible and affordable for members.
Why is Membership on the Decline?
It would be easy to blame declining professional membership on COVID, but the reality is this trend started long before the pandemic. Across healthcare, fewer clinicians are joining or renewing professional organizations. Cost is often the biggest factor. When budgets are tight, many people feel forced to choose one membership instead of several. Others question whether the return on investment is still there, especially when education, networking, and professional content are now easy to find online for free.
In my own field of dietetics, I also hear concerns about transparency and alignment with the future of the profession. The move to a master’s degree requirement without a meaningful increase in entry-level pay has created real frustration, particularly for early-career professionals and those from underrepresented backgrounds. Many feel their needs were not fully considered or advocated for during that transition.
These frustrations are valid. But they are also exactly why walking away may not be the answer. Professional practice groups are shaped by the people who show up. If something isn’t working, the most effective way to change it is to get involved.
The Case for Professional Membership
Despite the challenges, the benefits of professional membership far outweigh the drawbacks, and the opportunity to influence the future of your profession is worth staying engaged.
Mentorship That Isn’t Transactional
Social media platforms like LinkedIn, Substack, and X (formerly Twitter) are great for ideas and inspiration, but they rarely offer sustained, reciprocal mentorship. Most interactions are brief, one-sided, or tied to someone selling something.
Professional practice groups offer something different. They foster trusted relationships with people who have walked the same path and understand the realities of the work. Advice is shared openly, support develops over time, and there is no sales funnel attached. It is not a transaction. It is a co-op.
Space to Grow, Not Perform
Professional practice groups offer a space to ask questions without worrying about who is watching or how you are being perceived. There is room to be unsure, curious, or quietly ambitious, especially early in your career or during periods of transition.
Unlike social media, which often rewards confidence and visibility, professional groups tend to reward competence, growth, and thoughtful engagement. The focus is less on performance and more on learning and supporting one another as professionals.
Depth Over Virality
Most online content is designed for reach, not rigor. Professional practice groups focus on depth, offering evidence-based, peer-reviewed insights shared by professionals, for professionals. It is not about trends. It is about trust. As these professional practice groups evolve, many are also opening the door to honest conversations about topics once considered off-limits, such as workplace culture, compensation, and career options.
More Than a Membership
I’ve made meaningful connections on social media and learn something new every day from tools like ChatGPT. Those platforms have their place.
But when I want to understand where a profession is really headed, I look to professional practice groups. Who is presenting the research? What study resources are being recommended? Who is mentoring, volunteering, and helping shape the future of the field? These groups create space to contribute, learn, and grow alongside peers who care deeply about the work.
I’ve always respected my work colleagues, but I truly value my professional practice peers. I hope you will, too.
References:
- Southwest journal of pulmonary, critical care and sleep – editorials – the decline in professional organization growth has accompanied the decline of physician influence on healthcare. https://www.swjpcc.com/editorials/2024/5/16/the-decline-in-professional-organization-growth-has-accompan.html. Accessed December 13, 2025.
- Why professional associations aren’t engaging young professionals – highland. https://www.highlandsolutions.com/insights/why-professional-associations-arent-engaging-young-professionals. Accessed December 13, 2025.
- Markham MJ, Gentile D, Graham DL. Social Media for Networking, Professional Development, and Patient Engagement. Am Soc Clin Oncol Educ Book. 2017;37:782-787. doi:10.1200/EDBK_180077.
- Cline D, Curtin K, Johnston P. Professional organization membership: the benefits of increasing nursing participation. CJON. 2019;23(5):543-546. doi:10.1188/19.CJON.543-546
About Sarah
Sarah is the owner of Sarah Hormachea: Diabetes Care and Education, LLC. She is a long-time member of the Academy of Nutrition and Dietetics, the Association of Diabetes Care and Education Specialists (ADCES), and the American Diabetes Association (ADA). She currently serves as Webinar Chair for the Academy’s Diabetes Practice Group and is an incoming member of the ADCES Board of Directors. She is also enrolled in a women’s leadership development program through the ADA.
Learn More With Our Upcoming Courses
Question of the Week | Indications for DXA Assessment of Bone Mineral Density
According to the 2026 ADA Standards of Care, what individuals should be recommended to have a bone density evaluation using dual-energy X-ray absorptiometry to evaluate for bone loss?
- A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.
- A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.
- A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.
- A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.
Learn More From The Experts:
William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD
ENGAGING THE DISENGAGED | Live in San Diego at Marina Village
April 18th, 2026 from 9 AM to 4 PM PST!
In this course, William H. Polonsky, PhD, CDCES, and Susan Guzman, PhD, examine the powerful role of psychosocial factors in diabetes self-management. Through innovative strategies, participants will learn how to recognize and address common barriers to effective self-care and cardiometabolic medication initiation and maintenance, while fostering respectful, stigma-free clinical encounters.
Through a collaborative and person-centered approach, the course emphasizes communication strategies that enhance motivation, build confidence, and reinforce the value of self-management. Participants will develop skills in diabetes-focused action planning, addressing medication hesitancy, and providing ongoing support and resources to sustain behavior change over time. The goal is to help clinicians make diabetes care more doable, meaningful, and effective for people living with diabetes.
Non-Invasive Glucose Monitoring: Update for Clinicians
Did you know that in ancient times, diabetes was identified by the sweet taste of a person’s urine? Thankfully, science has come a long way from this ancient practice! The introduction of fingerstick blood glucose meters in the 1970s and continuous glucose monitors (CGMs) in the early 2000’s marked significant advancements in blood glucose monitoring. With more than 800 million people worldwide living with diabetes, interest in pain-free glucose testing is growing.1 Although current CGMs and fingerstick methods still require skin penetration, needle-free alternatives are being promoted, prompting many questions. Let’s discuss how healthcare professionals can address these products using evidence-based information.
What Is Noninvasive Glucose Monitoring?
Noninvasive (NI) glucose monitoring is a method of measuring blood glucose that does not involve breaking the skin. NI glucose monitoring technology under development includes: 2
- Electrochemical technology measuring glucose in alternative fluids such as saliva, sweat, and tears
- Near-infrared spectroscopy using a light source to measure glucose levels in blood vessels through the skin
- Infra-red light and AI technology, using a sensor on the finger, creating photo images that AI technology evaluates to measure blood glucose levels
- Radiofrequency and microwave sensors to measure glucose levels through tissue
- EEG sensor placed behind the ear to monitor blood glucose variations
Are Noninvasive Glucose Monitoring Devices Approved?
FDA approval is granted for glucose monitoring devices used for either medical or lifestyle management. FDA approval for medical management is based on sufficient evidence of safety and accuracy for people living with diabetes. FDA approval ensures adequate evidence to guide treatment decisions, such as insulin dosing. FDA approval for lifestyle use applies to individuals who do not use the device for the medical management of diabetes and who are not on insulin therapy.
Currently, no NI glucose monitoring devices have received FDA approval for medical management of diabetes. In 2024, the FDA issued a safety announcement that NI glucose devices could pose a possible threat to those with diabetes, as the FDA has not approved them.3 Numerous companies are currently in the research process to advance NI glucose monitoring devices toward FDA approval.
Using Noninvasive Glucose Monitoring in Diabetes Care
When considering noninvasive glucose monitoring, it’s essential to understand how these devices fit into everyday diabetes care. Despite the lack of FDA approval, clients can purchase NI glucose monitoring devices without a prescription. Clients may be using these before the healthcare provider is ever aware.
Individuals living with diabetes should be aware that many factors, including hydration status, skin characteristics, temperature, and movement, can affect NI glucose device readings. These devices may be better suited for detecting general trends but are not approved for making real-time treatment decisions. As diabetes healthcare professionals, we can provide guidance on the use of FDA-approved devices to verify readings and inform treatment decisions. Arming our clients with this information can help avoid frustration and unsafe treatment decisions.
Discussing Noninvasive Glucose Monitoring and Misinformation
Diabetes healthcare providers often approach noninvasive (NI) glucose monitoring with cautious optimism. While the appeal of “no more pokes” is understandable, clients may be influenced by strong marketing claims. As providers, our role is to meet clients where they are to start the conversation.
As with any other FDA-approved diabetes technology, not every device is the right fit for everyone. Ask clients about their diabetes goals, barriers, and assess their digital literacy. Address what clients are seeing on social media and online ads, and how these NI devices compare to current FDA-approved blood glucose monitoring technology.
Here are some helpful tips that can further the conversation:
- Work to understand the clients’ reasoning for wanting to use NI glucose monitoring
- Remain open-minded
- Encourage continued discussion with open-ended questions
- Provide education on risks, benefits, and available alternatives in a non-judgmental manner
As technology advances, we hope to see accurate and safe NI glucose monitoring options for those living with diabetes. Until then, we can partner with our clients to provide education and clinical insights on the latest trends in diabetes technology.
References:
- World Health Organization. (2024, November 14). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Key%20facts,stroke%20and%20lower%20limb%20amputation.
- Wu, J., Liu, Y., Yin, H., & Guo, M. (2023). A new generation of sensors for non-invasive blood glucose monitoring. American Journal of Translational Research, 15(6), 3825. https://pmc.ncbi.nlm.nih.gov/articles/PMC10331674/
- U.S. Food & Drug Administration. (2024, February 1). Do not use smartwatches or smart rings to measure blood glucose levels. [FDA Drug Safety Communication]. https://www.fda.gov/medical-devices/safety-communications/do-not-use-smartwatches-or-smart-rings-measure-blood-glucose-levels-fda-safety-communication
Learn More From Our Technology Expert:
Dr. Diana Isaacs
During Our Virtual DiabetesEd Training Conference
April 15th-17th, 2026
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 a handful of free bonus courses, serves as the ideal study companion! Plus, this content counts toward the ADA Standards requirements for CDCES Renewal.
With interactive co-teaching, we keep sessions engaging, relevant, and fun.
Let’s learn and grow together!
Course credits through AMA PRA Category 1 Credits™, ACPE, ANCC, and CDR!
Rationale of the Week | Indications for DXA Assessment of Bone Mineral Density
For last week’s practice question, we quizzed participants on what individuals should be recommended to have a bone density evaluation using dual-energy X-ray absorptiometry to evaluate for bone loss, according to the 2026 ADA Standards of Care. % 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
According to the 2026 ADA Standards of Care, what individuals should be recommended to have a bone density evaluation using dual-energy X-ray absorptiometry to evaluate for bone loss?
- A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.
- A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.
- A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.
- A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.
Getting to the Best Answer
Answer A is incorrect: % chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago. Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.
Answer B is incorrect: % chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.
Answer C is correct: % chose this answer, “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” This answer is correct. Per the 2026 ADA Standards of Care, bone health should be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.
Answer D is incorrect: % chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.
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!
Learn More About DKA & HHS
With Level 2 | Hyperglycemic Crises (DKA, HHS & EDKA) & Our CDCES Boot Camp!
Coach Bev’s Virtual Book Tour
Join Coach Beverly For Her Upcoming Virtual Book Tour!
February 20th, 2026 at 11:30 AM PST
Coach Beverly is thrilled you will be joining this special gathering and celebration!
During this virtual book launch, a special guest interviewer will join Coach Bev for a heartfelt conversation about why this book matters now and the real stories from clinical practice that inspired it. Coach Bev will also share the personal journey of writing Healing through Connection and how she discovered her voice along the way. We will conclude with an interactive question-and-answer session and allow time for connection.
Come celebrate connection, healing, and the power of story as we honor the shared human experience at the heart of healthcare.
