Let it FLOW – Semaglutide Approved for Renal Protection
FDA Expands Ozempic Approval to Protect Kidney (and Heart) Health in People with Type 2 Diabetes and Chronic Kidney Disease
Last month, the U.S. Food and Drug Administration (FDA) approved Ozempic (semaglutide) to reduce the risk of worsening kidney disease, kidney failure, and cardiovascular-related death in adults with type 2 diabetes and chronic kidney disease (CKD). This decision was based on results from the FLOW phase 3 clinical trial.
This expanded approval represents a major advancement for people managing both conditions, offering an additional tool to protect kidney function and heart health.
The Link Between Chronic Kidney Disease and Diabetes
Chronic kidney disease (CKD) is a serious and prevalent condition affecting about 30% of people living with diabetes. CKD can progress over time, potentially leading to kidney failure that requires dialysis or a transplant. Additionally, individuals with both CKD and diabetes face an elevated risk of cardiovascular complications, including heart attacks and strokes.
How Ozempic Benefits Individuals with Diabetes and CKD
Semaglutide (Ozempic) is a commonly used GLP-1, that not only lowers blood glucose levels and body weight, it has also been proven to reduce the risk of major cardiovascular events in adults with type 2 diabetes.
Now, with this latest FDA approval, semaglutide is also recognized for its ability to slow kidney disease progression and lower the risk of kidney failure and cardiovascular-related deaths in people with type 2 diabetes and CKD.
The Science Behind the Approval: FLOW Trial Results
The FDA’s decision was based on the FLOW phase 3b kidney outcomes trial, which involved 3,533 adults with type 2 diabetes and CKD. The study compared the effects of once-weekly semaglutide 1.0 mg injections versus a placebo. Findings revealed a 24% reduction in the risk of kidney disease worsening, kidney failure, and cardiovascular death in participants receiving semaglutide. Due to the overwhelming efficacy, the trial was stopped early after meeting its pre-specified criteria.
Expert Insights
Dr. Richard E. Pratley, Medical Director at the AdventHealth Diabetes Institute in Orlando, FL, and Co-Chair of the FLOW Trial, emphasized the significance of this approval:
“Managing type 2 diabetes is already challenging, and chronic kidney disease adds another layer of complexity. In my practice, I see many patients with serious kidney complications—some requiring dialysis. The FDA’s decision provides new hope and an additional treatment option that can make a meaningful difference in protecting kidney function and cardiovascular health.”
What This Means for Individuals with Diabetes and CKD
For individuals living with both type 2 diabetes and CKD, semaglutide offers a new treatment option to help preserve kidney function and lower the risk of life-threatening cardiovascular events. Effectively managing both conditions can improve long-term health outcomes and quality of life.
If you are working with individuals with type 2 diabetes and CKD, initiating semaglutide early in the treatment plan can not only protect kidney health but also decrease the risk of worsening kidney function, further improving outcomes.
Conclusion
The FDA’s expanded approval of Ozempic marks a crucial milestone for people with type 2 diabetes and CKD. With strong clinical trial evidence supporting its effectiveness, this treatment provides renewed hope for those at risk of worsening kidney disease and cardiovascular complications.
See our Medication PocketCards for more information.
NEJM Article: Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes
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Rationale of the Week | What defines overbasalization according to 2025 ADA Standards?
For last week’s practice question, we quizzed participants on what defines overbasalization according to 2025 ADA Standards?. 52% 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:
What defines overbasalization according to 2025 ADA Standards?
According to the new 2025 ADA Standards of Care, which of the following most accurately reflects overbasalization?
Answer Choices:
- basal insulin doses exceeding 0.5 units/kg/day
- significant bedtime-to-morning or postprandial-to-preprandial glucose differential
- low glycemic variability
- basal insulin dose exceeding 50 units twice per day
Getting to the Best Answer
Answer 1 is incorrect. 25% chose this answer: basal insulin doses exceeding 0.5 units/kg/day. This year, the ADA Recommendation was revised to remove consideration of basal insulin doses exceeding 0.5 units/kg/day as evidence of overbasalization. Instead, signs of overbasalization including significant bedtime-to-morning or postprandial-to-preprandial glucose differential, occurrences of hypoglycemia (aware or unaware), and high glycemic variability should be used.
Answer 2 is correct. 52% of you chose this answer: significant bedtime-to-morning or postprandial-to-preprandial glucose differential. GREAT JOB! In the 2025 ADA Standards (9), they define overbasalization as significant bedtime-to-morning or postprandial-to-preprandial glucose differential, occurrences of hypoglycemia (aware or unaware), and high glycemic variability.
Answer 3 is incorrect. About 18% of respondents chose this: low glycemic variability, This is a juicy and tempting answer. However, high glycemic variability (lots of ups and downs) is more closely associated with hypoglycemia.
Finally, Answer 4 is incorrect 3% chose this answer: basal insulin dose exceeding 50 units twice per day. Overbasalization is not defined by the amount of insulin used, but by the glucose response including significant bedtime-to-morning or postprandial-to-preprandial glucose differential, occurrences of hypoglycemia (aware or unaware), and high glycemic variability
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!
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Diabetes Mentorship Program Kicks-Off in Northern Cal
Dignity Health Mercy Medical Center Redding Steps Up with a Diabetes Mentorship Program!
We are thrilled to announce the launch of the Diabetes Mentorship Program at Mercy Medical Center in Redding, designed to support and guide the next generation of diabetes educators. This unique opportunity is tailored for eight motivated mentees who are eager to gain hands-on experience in diabetes care, all while learning from Janelle Revnak, MS, RDN, CDCES, an experienced diabetes care and education specialist, with 10 years practicing as an RDN and 5 years as a CDCES. Janelle is passionate about sharing her expertise with the next generation of diabetes professionals. Her extensive background in both outpatient and inpatient diabetes education will ensure that mentees receive comprehensive training and valuable insights into the world of diabetes care.
Over the course of the program, mentees will attend monthly educational sessions led by Janelle, coupled with didactic learning sessions and job shadowing, providing an immersive experience in the inpatient setting. As part of our mentoring partnership, the trainees will also have access to our Diabetes Boot Camp series. Janelle decided to start this program after realizing that the need for diabetes education in her rural community was larger than what one person could realistically deliver. She reached out and identified colleagues in her hospital who were interested upping their diabetes knowledge and improving care.
“I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” – Mother Teresa
Increasing Demand for Diabetes Care and Education Specialists
As the number of people living with diabetes continues to rise, the demand for skilled diabetes educators is paramount. According to the latest CDC Data, the prevalence of diabetes has increased dramatically over the past decade, with more than 37 million Americans now living with diabetes—an increase of nearly 30% over the past 10 years. This growing population needs more than just medical care; they require specialized education and support to effectively manage their condition. Current diabetes care and education specialists (DCES) are uniquely positioned to assist in equipping future professionals with the knowledge and experience needed to meet the needs of this expanding patient population.
The mentorship program will be held once a month and is designed to create a balanced approach to learning. Mentees will dive deep into didactic topics, such as advanced diabetes management, behavior change strategies, and innovative approaches to diabetes care. In addition to classroom-style learning, they will have the opportunity to job-shadow Janelle, gaining firsthand experience in how diabetes education is applied in real-world inpatient clinical settings. This combination of theory and practice ensures mentees are well-equipped to make an impact in the field.
Participants will also have the chance to engage with a wide range of diabetes-related cases during their job shadowing. From inpatient diabetes clinical management to individualized patient education, they will develop a well-rounded understanding of the crucial role diabetes educators play in improving care outcomes while helping individuals feel emotionally supported through this challenging disease. This hands-on approach allows for active learning and real-time feedback, which is vital for shaping confident and competent DCES.
The mentorship program is not just about learning—it’s about making connections, fostering growth and building a community of passionate diabetes care professionals. We are excited to offer this incredible opportunity to those who are committed to advancing their skills and knowledge in diabetes education. Together, we can make a real difference in the lives of those living with diabetes. In the spirit of Mother Teresa, it is not one person alone that can impact the growing population affected by diabetes, but working together, we can achieve meaningful change.
If you have questions, you can reach Janelle at [email protected].
Are you Interested in Starting a Mentorship Program?
As part of our Bridge Program, Coach Beverly wants to support YOUR efforts to mentor a new generation of Diabetes Care and Education Specialists. If you are a mentor, we are offering significant discounts off of our Diabetes Boot Camp or Virtual 3 Day Program for groups of mentees who are practicing in underserved regions of our country. Please email us for more information at [email protected]
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Question of the Week | ADA 2025: Intensive Prevention for High-Risk Individuals with BMI >35 kg/m2
According to ADA 2025 Standards, more intensive preventive approaches should be considered in individuals who are at particularly high risk of progression to diabetes, including individuals with BMI ≥35 kg/m2 who:
- Sit more than eight hours a day and have a sedentary lifestyle.
- Have a history of thyroid or celiac disease.
- Consume a diet with high amounts of simple carbohydrates.
- Have fasting plasma glucose of 110–125 or A1C ≥6.0%.
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“As always, Bev delivers comprehensive human-centered material to make me a better educator and leader.“- DiabetesEd Student
We hope to see you there!
Rationale of the Week | ADA Standards identify another 1st Line med to treat kidney disease. Which one?
For last week’s practice question, we quizzed participants on ADA Standards identify another 1st line med to treat kidney disease. 63.39% 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 ADA 2025 Standards, new clinical trials suggest that another diabetes medication (besides SGLT-2i) can be used as a first line agent to treat chronic kidney disease.
Which of the folowing diabetes meds is effective as a first-line agent for people with CKD?
Answer Choices:
- Afrezza inhaled insulin
- Semaglutize (Ozempic)
- Amylin (Pramlintide)
- Sitagliptin (Januvia)
Getting to the Best Answer
Answer 1 is incorrect. 2% chose the answer, Afrezza inhaled insulin. Insulin helps lower blood glucose levels, which contributes to improved overall vessel health. However, there are currently no specific studies supporting the use of Afrezza as a first-line treatment strategy for managing chronic kidney disease.
Answer 2 is correct. 63.39% of you chose this answer the best answer, semaglutide (Ozempic). GREAT JOB! According to the 2025 ADA Standards, “a recent clinical trial suggests that the GLP-1 RA semaglutide has a beneficial effect on CVD, mortality, and kidney outcomes among people with Chronic Kidney Disease (CKD), leading to the recommendation that semaglutide can be used as another first-line agent for people with CKD.”
Answer 3 is incorrect. About 12.34% of respondents chose Amylin (Pramlintide). Amylin is an injected hormone mimetic that helps lower blood glucose levels. However, there are currently no specific studies supporting the use of Amylin as a first-line treatment strategy for managing chronic kidney disease.
Finally, Answer 4 is incorrect. 22.38% chose this answer, Sitagliptin (Januvia). Sitagliptin helps lower A1C levels by 0.5-0.7%. However, there are currently no specific studies supporting the use of sitagliptin as a first-line treatment strategy for managing chronic kidney disease.
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?
Enroll in our Standards of Care Course
This is our most popular course of the year, offering the perfect opportunity to immerse yourself in the essential content featured in this comprehensive 300-page clinical guidebook.
“As always, Bev delivers comprehensive human-centered material to make me a better educator and leader.“- DiabetesEd Student
We hope to see you there!
Question of the Week | What defines overbasalization according to 2025 ADA Standards?
According to the new 2025 ADA Standards of Care, which of the following most accurately reflects overbasalization?
- basal insulin doses exceeding 0.5 units/kg/day
- significant bedtime-to-morning or postprandial-to-preprandial glucose differential
- low glycemic variability
- basal insulin dose exceeding 50 units twice per day
Want to learn more about this question?
Enroll in our Diabetes Mastery & Cert Readiness
Ready to ace your diabetes certification exams? Our Level 3 courses are the ultimate step in your exam prep journey, designed to fill in any knowledge gaps and solidify your expertise. Whether you’re preparing for the CDCES or BC-ADM exams, these master-level courses offer comprehensive, evidence-based content grounded in the latest ADA Standards of Care in Diabetes.
Dive into critical areas like pharmacology, technology, lifestyle management, and Medical Nutrition Therapy, all while building the practical and strategic skills you need to deliver top-notch care. With video presentations, podcasts, practice tests, and engaging case studies, you’ll gain the confidence and competence to navigate complex diabetes scenarios. Plus, enjoy access to your course materials for a full year! Sign up now and set yourself up for certification success!
Rationale of the Week | Diabetes & Malnutrition Risk
For last week’s practice question, we quizzed participants on Diabetes & Malnutrition Risk 74.26% 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: The 2025 ADA Standards of Care have added recommendations for malnutrition screening.
According to these updated standards, who could be at risk for malnutrition?
Answer Choices:
- An individual with a BMI of 38 and 21% weight loss in the past 6 months.
- An individual on incretin therapy with intentional 18-pound weight loss in the past 2 months.
- An 86-year-old with type 1 diabetes and reported recent decline in activity and strength.
- All the above
Getting to the Best Answer
Answer 1 is incorrect. 10.54% chose this answer: “An individual with a BMI of 38 and 21% weight loss in the past 6 months”. Although Answer A is true, it is not the best answer. Malnutrition risk is not solely based on BMI. According to the 2025 ADA Standards of Care, individuals with diabetes experiencing significant weight loss, greater than 20%, may be at risk for malnutrition regardless of starting BMI.
Answer 2 is incorrect. 4.90% of you chose this answer: “An individual on incretin therapy with intentional 18-pound weight loss in the past 2 months.” This answer is also true, but there is a better answer. Even though the weight loss was intentional on incretin therapy, a rapid drop in weight, more than 4 kg/month, can still place an individual at risk for malnutrition. Monitoring nutrition status during weight loss pharmacotherapy is essential.
Answer 3 is incorrect About 10.29% of respondents chose this: “An 86-year-old with type 1 diabetes and reported recent decline in activity and strength”. This answer is true but not the best answer. Older adults, especially those with type 1 diabetes, are at greater risk for malnutrition, particularly when they experience declines in physical activity and strength. Malnutrition and sarcopenia, a loss of lean body mass, may develop simultaneously.
Finally, Answer 4 is correct. 74.26% chose this correct answer – GREAT JOB! All these scenarios indicate an increased risk of malnutrition and warrant additional screening. The ADA Standards of Care emphasize screening for malnutrition in individuals who have lost significant weight, especially individuals’ post-metabolic surgery, on incretin therapy, and individuals managing multiple chronic conditions who may experience an increased risk of developing sarcopenia and malnutrition. Check out the 2025 ADA Standards of Care Section 5 and Section 8 for the latest on malnutrition screening recommendations.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Join us live on Jan. 30th for our
Standard of Care Course
Level 2
Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses for 1 year after your purchase date. Each online course includes a: video presentation, podcast, practice test, and additional resources.
This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the annual updates to the American Diabetes Association’s (ADA) Standard of Medical Care in Diabetes & provides critical teaching points & content for healthcare professionals involved in diabetes care & education.
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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.
Cheat Sheet Updates – Reflect 2025 ADA Standards
At the beginning of each year, Coach Beverly excitedly scans the new ADA Standards to discover updates and advances in diabetes care. She then integrates these new findings into our Cheat Sheets.
Notable updates include our at-a-glance Screening and Diagnosis of Diabetes, Immunization Schedule, Insulin Storage and Dispensing Information and our Lipids and Hypertension Medication Summary Sheet and more.
You can access the complete Cheat Sheet Library on our website and on our CDCES Coach App. We are proud of our 25-year history of creating original materials that to meet the rigorous standards set by the CDR Accreditation Committee and hope you find them useful in your clinical practice and in your preparation for certification exams.
Cheat Sheet Updates based on 2025 Standards
ADA Standards of Care 2, Diagnosis and Classification of Diabetes includes additional details on screening for type 1 and type 2 diabetes and diabetes in pregnancy. The diagnostic testing methods and criteria remained the same as in past years. However, the ADA notes that there is lower sensitivity of A1C at the designated cut point compared with that of 2-h PG as well as limited access in some parts of the world.
1.) Screen those at risk for presymptomatic type 1 diabetes and those with type 1 phenotypic risk (younger age, ketoacidosis, etc.) by testing autoantibodies to insulin, GAD, islet antigen 2, ZnT8
2.) For Type 2 diabetes, screen everyone starting at age 35, but screen people with prediabetes yearly and those with GDM every 1-3 years.
3.) Additional risk factors for earlier screening were added and a few were modified from last year. See new additions in bold. The ADA added monitoring for hyperglycemia in those taking high-risk medicines (steroids, HIV meds, antipsychotic meds, statins, thiazide diuretics ) or a history of pancreatitis or periodontal disease and re-checking glucose levels at least annually or if any signs of hyperglycemia.
4.) In the diabetes and pregnancy section, the ADA still strongly recommends screening all people at the first prenatal visit (before 15 weeks) to help detect undiscovered hyperglycemia and initiate early treatment.
The update for this Insulin Storage and Dispensing sheet is inspired by Tyler Whitaker, PharmD, BC-ADM, CDCES. Tyler reached out to let us know about needed additions, updates and changes to this content. He said he uses this information all the time in his clinical practice and he was happy to give back. I want to thank Tyler for helping us improve this resource and for his thoughtful review of earlier drafts and this final version. I appreciate being a part of this wonderful community of educators who are invested in supporting each other to succeed.
Updates to this Cheat Sheet include approval for Lyumjev in insulin pumps, removal of detemir insulin and clarification of the the 70/30 insulins’ shelf life, packaging and cost information.
This chart, compiled based on ADA Standard 4, details the types of vaccines, when, and how often they are recommended for people with diabetes. The recommendations in general were very similar to last year. The COVID-19 vaccine and boosters are suggested starting at six months of age.
This standard emphasized reminding people with diabetes to avoid the live attenuated influenza vaccine and it included additional clarification on the pneumonia vaccines. For a comprehensive list of vaccines, refer to the Centers for Disease Control and Prevention web site at cdc.gov/vaccines/.
For the content included in these 5 pages, our resident expert pharmacist updated dosing ranges, considerations and added newer lipid lowering and blood pressure medications to this comprehensive list. A special shout out to our expert and my husband, Kristapor Thomassian, PharmD, BCPS, for his hours of review, edits and content negotiations with the company CEO and wife of 26 years.
If you are preparing for the CDCES exam, you will need to be familiar with the most common blood pressure and cholesterol medication classes and side effects along with when they are indicated based on the ADA Standards. For the BC-ADM exam, you will need to know the same information but in more detail, imagining you would be familiar enough with these medications to prescribe them or make need adjustments and additions.
We hope you will stop by our complete Cheat Sheet Library!!
ADA Standards of Care 2025 Webinar Update
Join us live on Jan. 30th @ 11:30am PST
Our Level 2 Courses make learning the ADA Standards of Care easy and effective by breaking them down into bite-sized, essential topics for clinical practice and exam prep. You can follow the course order based on the Standards, or choose your own path, starting with what you know least and building from there.
This course is perfect for healthcare professionals looking to master the ADA Standards for better clinical practice or for those preparing for the BC-ADM or CDCES exams.
Each webinar focuses on key content, helping you make the most of your study time. Our instructor also uses polls to highlight important concepts, so you can test your knowledge and pick up the best exam strategies.
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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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