As the shortest day of the year, Winter Solstice marks a turning point in the rhythms of life. Tomorrow, the sun will start shining longer and longer each day, bringing increased illumination and the promise of new growth and hope. Thank you for being a messenger of hope and light for people living with diabetes. Love, Coach Beverly

The Buddha’s Last Instruction by Mary Oliver

“Make of yourself a light,”
said the Buddha,
before he died.
I think of this every morning
as the east begins
to tear off its many clouds
of darkness, to send up the first
signal — a white fan
streaked with pink and violet,
even green.
An old man, he lay down
between two sala trees,
and he might have said anything,
knowing it was his final hour.
The light burns upward,
it thickens and settles over the fields.
Around him, the villagers gathered
and stretched forward to listen.
Even before the sun itself
hangs, disattached, in the blue air,
I am touched everywhere
by its ocean of yellow waves.
No doubt he thought of everything
that had happened in his difficult life.
And then I feel the sun itself
as it blazes over the hills,
like a million flowers on fire —
clearly I’m not needed,
yet I feel myself turning
into something of inexplicable value.
Slowly, beneath the branches,
he raised his head.

1. In general, insulin pens expire after 10-14 days at room temperature.
2. Insulin kept for more than 28 days at room temperature needs to be discarded.
3. JR can put the degludec (Tresiba) back in the refrigerator and use until the expiration date.
4. Degludec (Tresiba) can be safely stored at room temperature for up to 56 days.

Click Here to Test your Knowledge

---

Studying for the CDCES Exam? Enroll in our

CDCES Deluxe Prep Bundle | 30+ Online Courses + Bonus Items | 47 CEs

Included in this bundle

• Level 1 focuses on the fundamentals and introduces each topic area for the exam.
• Level 2 deep dives into the ADA Standards of Care, 
• Level 3 AKA Boot Camp is a more accelerated level that focuses on test simulation for finding the best answer to get you to the finish line of your study path.
• Technology Toolkit which gives information on pumps, sensors, and calculations,
• Test Taking Toolkit includes over 220 practice questions for test simulation plus a webinar where Coach Beverly provides test-taking tips based on her experience taking the certification exam six times. 
• ADCES Review Guide for the Diabetes Care and Education Specialist Exam – 5th Edition – Revised – The ADCES Review Guide is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam. This book includes 480 + multiple-choice questions and strategies for preparing for and taking the exam with an answer key with rationales for all questions! 
• Medication PocketCard – Our four-sided medication accordion Pocketcards were designed by Coach Beverly Thomassian to assist in clinical practice and exam preparation.
• Tote Bag

---

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!

---

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.

For last week’s practice question, we quizzed test takers on Rezvoglar insulin. 75% 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:

RZ takes 30 units of glargine (Lantus) each night. However, when they went to the pharmacy to pick up their prescription, they received glargine insulin Rezvoglar instead of their usual Lantus.

RZ asks how the pharmacy can give them a different brand of insulin without checking first? After addressing their emotional response, you provide the following, most accurate Information.

Answer Choices:

1. Rezvoglar is the generic version of (glargine) Lantus.
2. Rezvoglar is an interchangeable biosimilar insulin.
3. Rezvoglar can not be switched for glargine (Lantus) without provider approval.
4. Rezvoglar is a rapid acting human biosimilar insulin analog

---

Getting to the Best Answer

Answer 1 is incorrect. 12.73% chose this answer, “Rezvoglar is the generic version of (glargine) Lantus.” This is a very tempting answer, but since insulin is a biologic medication, (biologic medications are large, complex molecules, often made from living cells or tissue) the term “generic” is replaced with “biosimilar”. In addition, the better answer below is more accurate, and offers additional information.

Answer 2 is correct. 74.97% of you chose this answer, “Rezvoglar is an interchangeable biosimilar insulin.” YES, GREAT JOB. The FDA just announced that Rezvoglar has also been approved as an interchangeable biosimilar along with Semglee. An “interchangeable biosimilar,” means that pharmacists can substitute a person’s Lantus prescription with these cheaper alternatives without needing to consult the healthcare prescriber.

Answer 3 is incorrect. 9.17% of respondents chose this answer, “Rezvoglar can not be switched for glargine (Lantus) without provider approval.” With recent FDA approval, Rezvoglar is now an “interchangeable biosimilar,” which means that pharmacists can substitute a person’s Lantus prescription with this cheaper alternative without needing to consult the healthcare prescriber.

Finally, Answer 4 is incorrect. 3.13% chose this answer, “Rezvoglar is a rapid-acting human biosimilar insulin analog.” Rezvoglar is the biosimilar of basal insulin glargine.

Thank you so much for reading this “Rationale of the Week”.

Newly Approved Biosimilar Interchangeable Basal Insulin – PocketCard Update

Under basal insulin glargine, there are now 3 biosimilars listed; Basaglar, Semglee and Rezvoglar. The FDA just announced that Rezvoglar has also been approved as an interchangeable biosimilar along with Semglee. An “interchangeable biosimilar,” means that pharmacists can substitute a person’s Lantus prescription with these cheaper alternatives without needing to consult the healthcare prescriber.

Get Your Own PocketCard
These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.

 

---

Want to learn more about this question? Join us for our

Diabetes Fundamentals 2023 Updates | Level 1
$119 | 9+ CEs

Updates air live between Jan 10, 2023-Jan 26, 2023, at 11:30 am PST

This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.

2023 Webinar Dates

1. January 10, 2023 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
2. January 12, 2023 – Class 2 – Nutrition and Exercise 1.5 CEs
3. January 17, 2023 – Class 3 – Meds Overview for Type 2 – 1.5 CEs
4. January 19, 2023 – Class 4 – Insulin Therapy & Pattern Management 1.5 CEs
5. January 24, 2023 – Class 5 – Goals of Care – 1.5 CEs
6. January 26, 2023 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

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 Certification Exam.

 

---

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.

1. Hypertension is now defined as a systolic blood pressure greater than or equal to 130 or a diastolic blood pressure greater than or equal to 80.
2. Hypertension is now defined as a systolic blood pressure greater than or equal to 130 and a diastolic blood pressure greater than or equal to 80.
3. Hypertension is now defined as a systolic blood pressure greater than or equal to 140 or a diastolic blood pressure greater than or equal to 90.
4. Hypertension is now defined as a systolic blood pressure greater than or equal to 140 or a diastolic blood pressure greater than or equal to 80.

Click Here to Test your Knowledge

---

Want to learn more about this question? Join us for our

Level 2 | ADA Standards of Care CE Course | 2.0 CEs

Updates air live between Feb. 2, 2023, at 11:30 am PST

This course, updated annually, is an essential review for anyone in the field of diabetes. Join Coach Beverly as she summarizes the 2023 updates to the American Diabetes Association’s Standards of Medical Care in Diabetes and provides critical teaching points and content for healthcare professionals involved in diabetes care and education.

Objectives:

1. List significant changes and updates to the 2023 ADA Standards of Medical Care.
2. State 3 updates on new blood pressure and lipid goals.
3. Identify 5 key elements of the position statement.
4. Discuss how to apply the Standards in the clinical setting and in preparation for exam success.

Intended Audience:  This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, 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 prediabetes, diabetes and other related conditions.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

Studying for the CDCES Exam? Enroll in our

CDCES Deluxe Prep Bundle | 30+ Online Courses + Bonus Items | 47 CEs

Included in this bundle

• Level 1 focuses on the fundamentals and introduces each topic area for the exam.
• Level 2 deep dives into the ADA Standards of Care, 
• Level 3 AKA Boot Camp is a more accelerated level that focuses on test simulation for finding the best answer to get you to the finish line of your study path.
• Technology Toolkit which gives information on pumps, sensors, and calculations,
• Test Taking Toolkit includes over 220 practice questions for test simulation plus a webinar where Coach Beverly provides test-taking tips based on her experience taking the certification exam six times. 
• ADCES Review Guide for the Diabetes Care and Education Specialist Exam – 5th Edition – Revised – The ADCES Review Guide is a fantastic independent study tool and comprehensive resource for the Diabetes Care and Education Specialist Exam. This book includes 480 + multiple-choice questions and strategies for preparing for and taking the exam with an answer key with rationales for all questions! 
• Medication PocketCard – Our four-sided medication accordion Pocketcards were designed by Coach Beverly Thomassian to assist in clinical practice and exam preparation.
• Tote Bag

---

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!

---

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.

December Greetings

We decided to get a little personal and share some tenderness, alongside our newsy pieces, for this month’s newsletter.

For Coach Beverly, three words come to mind when she considers her family and business this year: reopening, celebration, and reflection. In her article, Beverly shares insights on the evolution of her company and her family over the past 24 years, including a historical photo of her first-ever Medication PocketCard.

Bryanna shares news on her two recent adoptees, Biscuit and Muffin. They are each adorable in their own way, and Bryanna hopes that they will eventually bring out the best in each other. 

We welcome Andrew, a nursing student and new team member to our Diabetes Education Services family.

On the news front, we made significant changes to the timing section of our Insulin Medication PocketCards. We have also added Rezvoglar to the Lantus biosimilar list.

You’re invited to take the Question of the Week and read about the ADA/EASD consensus report with our Rationale of the week.

Finally, we want to turn the spotlight on you! We are forever grateful for your willingness to support and believe in a young Diabetes Specialist who had the vision to create a company that uplifts people with diabetes through a blend of science and compassion.

To thank you, our amazing community of diabetes educators and advocates, we will be celebrating our 25th Anniversary throughout 2023 with special events and giveaways. We can’t wait!

In celebration,

Coach Beverly and Bryanna

Featured Articles

• Insulin PocketCard Update
• Coach Bev Reflects
• Meet Biscuit and Muffin
• Welcome Andrew
• Question of the Week
• Rationale of Week
• Meds for Type 2 Webinar
• Upcoming Events – See complete calendar listing

FREE Resources

• Surviving the Holidays
• Prep for CDCES Webinar
• Test Taking Toolkit Webinar
• Free Resource Catalog

---

December Live Webinar Schedule

Join us for our Live Webinar 2023 Updates!

December 13, 2022 – FREE: Test Taking Practice Exam Toolkit

December 14, 2022 – FREE: CDCES or BC-ADM – Which Certification is Right for me?December 15, 2022 – New ADA/EASD Meds Consensus Update| Level 2 |1.5 CE’s

December 20, 2022 – Assessing Well-Being: A Person-Centered Approach | 1.5 CEs

---

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!

---

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.

For last week’s practice question, we quizzed test takers on PZ who is upset by a recent diabetes diagnosis. 64% 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:

PZ is very upset that they were just diagnosed with diabetes and state “I want to get rid of this diabetes”. PZ has a BMI of 35 and elevated LDL cholesterol levels. Both of PZ’s parents had diabetes and died due to complications. 

Based on the newly released ADA/EASD Consensus Statement, which intervention is recommended to get blood sugars to target and possibly lead to type 2 remission?

Answer Choices:

1. Start an SGLT-2 Inhibitor plus metformin
2. Lose 10-15% of current weight
3. Immediately initiate a walking and strength training program.
4. Encourage insulin pump therapy to preserve beta cell function.

---

Getting to the Best Answer

Answer 1 is incorrect. 26.34% chose this answer, “Start an SGLT-2 Inhibitor plus metformin.” This was a juicy answer, but not the best answer. The ADA/EASD consensus statement suggests starting combination therapy for people with an A1C of 8.5% or greater. However, in this case study, there is no information on PZ’s glucose level, therefore we can’t suggest initiating combination diabetes therapy.

Answer 2 is correct. 63.55% of you chose this answer, “Lose 10-15% of current weight.” YES, GREAT JOB. According to the ADA/EASD Consensus Statement, weight reduction as a targeted intervention can dramatically improved outcomes. “Weight loss of 5–10% confers metabolic improvement; weight loss of 10–15% or more can have a disease-modifying effect and lead to remission of diabetes, defined as normal blood glucose levels for 3 months or more in the absence of pharmacological therapy”. Plus, weight loss provides benefits that extend beyond glycemic management to decrease cardiometabolic risk factors and improve quality of life. In addition to referring all people with diabetes to a RD/RDN for MNT and encouraging regular activity, we can also recommend newer pharmacologic agents that not only lower glucose but support weight loss.

Answer 3 is incorrect. 7.50% of respondents chose this answer, “Immediately initiate a walking and strength training program.” While strength training and physical activity are both critical to promote health and improve insulin sensitivity, they will probably not be enough, by themselves, to get PZ’s A1C to target.

Finally, Answer 4 is incorrect. 2.60% chose this answer, “Encourage insulin pump therapy to preserve beta cell function.” While many people with type 2 diabetes are opting to use insulin pump therapy, initiating someone on insulin pump therapy before trying lifestyle and pharmacologic agents is not a recommended approach based on the latest consensus statement.

Thank you so much for reading this “Rationale of the Week”. You can download our Medication PocketCard or join our Webinar below for more information.

---

Want to learn more about this question? Join us for our

Meds for Type 2 Update; New ADA/EASD Consensus Statement
Level 2 | 1.25 CEs

Airs live on Wednesday, December 15th at 11:30 am PST

Plan on joining this exciting webinar that walks participants through the newly released, “Management of Hyperglycemia in Type 2 Consensus Report by the ADA and EASD”.  These updated guidelines will be incorporated into the 2023 ADA Standards of Care, but you can get a early sneak peak by joining Coach Beverly on December 1st, 2022.  She will highlight the revised guidelines with a focus on new elements and exciting changes on how we approach medication management for type 2 diabetes. Together, we will explore clinical factors to consider when determining the best strategy to improve glucose management in people with type 2 diabetes and other co-conditions. There will be a special focus on cardiovascular risk reduction and renal protection and addressing clinical inertia.

Objectives:

1. Describe the role of Diabetes Care and Education Specialists in advocating for optimal therapeutic approaches.
2. Discuss the application of the new ADA/EASD Guidelines to improve glucose and reduce CV and renal risk.
3. List strategies to initiate and adjust oral and injectable therapy using a person-centered approach

Intended Audience:  A great course for health care professionals seeking evidence-based information that improves the quality of life and outcomes.

---

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.

1. Rezvoglar is the generic version of (glargine) Lantus.
2. Rezvoglar is an interchangeable biosimilar insulin.
3. Rezvoglar can not be switched for glargine (Lantus) without provider approval.
4. Rezvoglar is a rapid acting human biosimilar insulin analog

Click Here to Test your Knowledge

---

Want to learn more about this question? Join us for our

Diabetes Fundamentals 2023 Updates | Level 1
$119 | 9+ CEs

Updates air live between Jan 10, 2023-Jan 26, 2023, at 11:30 am PST

This bundle is specifically designed for healthcare professionals who want to learn more about diabetes fundamentals for their clinical practice or for those who are studying for the Certified Diabetes Care and Education Specialist (CDCES) exam.

2023 Webinar Dates

1. January 10, 2023 – Class 1 – Getting to the Nitty Gritty 1.5 CEs
2. January 12, 2023 – Class 2 – Nutrition and Exercise 1.5 CEs
3. January 17, 2023 – Class 3 – Meds Overview for Type 2 – 1.5 CEs
4. January 19, 2023 – Class 4 – Insulin Therapy & Pattern Management 1.5 CEs
5. January 24, 2023 – Class 5 – Goals of Care – 1.5 CEs
6. January 26, 2023 – Class 6 – Hypoglycemia, Sick Days, Monitoring, Foot Care 1.5 CEs

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 Certification Exam.

---

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.

Effective Onset, Peak & Action Times

We love and respect our diabetes community. If someone reaches out and asks questions, we listen and investigate. Over the past few months, several of you emailed us, suggesting a needed change to the effective onset, peak and duration times for the very rapid and rapid acting analogs on our PocketCards.

Coach Beverly sprang into action and revisited the package inserts from the various insulin manufacturers in an attempt to solve the timing mystery and set things right.

After taking a closer look at the information, she realized where the confusion came in.
The effectiveness of insulin is not just based on pharmacokinetics, there is also a dose dependent response curve. In studies cited in the package inserts, there are tables with insulin timing based on different doses. In general, the larger the insulin dose, the faster the effective onset of action, but the longer duration of action (see the table for Fiasp below)

In addition, she discovered that terminology has evolved. For example, the onset of insulin (when it appears in the blood circulation) can be as short as a few minutes. However, the most important measurement for real life is time to first measurable effect (effective onset) or the amount of time it takes for the insulin to kick in and start lowering blood glucose levels. In addition, instead of using the term “duration” in the package inserts, they now use, “Time for effect to return to baseline”, which is more accurate but way too long to fit on our Pocketcard.

Called in the experts

To sort through all of this, Coach Beverly reached out to her favorite pharmacist and husband, Kristapor Thomassian, PharmD, BCPS for consultation. After reviewing all of the package inserts and online pharmacy resources, he recommended standardizing the card and using the term “effective” ranges for the action, onset and duration times of various insulins.

These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.

Insulin action has many variables

As we all know, these insulin timing charts just provide a general framework. Insulin absorption, onset, peak and duration results from a complex interplay between the insulin dose, injection site, circulating hormones, skin temperature, metabolic rate and so many other factors. The package inserts recognize that there is about at 20% day-to-day variability of insulins effectiveness and that was in a controlled research environment.

The famous chart by Adam Brown (below) and first posted on DiaTribe, clearly and succinctly highlights 42 factors that affect glucose. The bottom line is that insulin absorption timing varies within individuals. Over time, many people can determine the best time to inject the bolus of insulin or adjust their dose based on personal experience and blood glucose response.

Newly Approved Biosimilar Interchangeable Basal Insulin – PocketCard Update

Under basal insulin glargine, there are now 3 biosimilars listed; Basaglar, Semglee and Rezvoglar. The FDA just announced that Rezvoglar has also been approved as an interchangeable biosimilar along with Semglee. An “interchangeable biosimilar,” means that pharmacists can substitute a person’s Lantus prescription with these cheaper alternatives without needing to consult the healthcare prescriber.

Get Your Own PocketCard
These updates are now posted on the latest version of our Insulin PocketCards, which are available for FREE download, or on our CDCES Coach App. You can also purchase your very own 2023 laminated version and they make perfect gifts for team members.

A special thanks to those of you who alerted us to these needed updates. We love our community!

---

Want to learn more about this topic? Join us for our

DiabetesEd Boot Camp 2023 Updates | Level 3
$279 | 12+ CEs

Updates air live between Feb 7, 2023-March 9, 2023, at 11:30 am PST

In each webinar, Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM highlights the critical content of each topic area so you can focus your study time most efficiently. She also launches multiple poll questions that highlight key concepts to help students assess their knowledge and learn the best test-taking strategies. 

2023 Webinar Dates

1. February 7, 2023 – Class 1 – Diabetes – Not Just Hyperglycemia 1.5 CEs
2. February 9, 2023 – Class 2 – Standards of Care & Cardiovascular Goals 1.5 CEs
3. February 14, 2023 – Class 3 – Meds for Type 2 – What you need to know 1.5
4. February 16, 2023 – Class 4 – Insulin Therapy – From Basal/Bolus to Pattern Management 1.5 CEs
5. February 21, 2023 – Class 5 – Insulin Intensive – Monitoring, Sick Days, Lower
6. February 23, 2023 – Class 6 – Exercise and Medical Nutrition Therapy 1.5 CEs
7. February 28, 2023 – Class 7 – Screening, Prevention, and Treatment of Microvascular Complications
8. March 2, 2023 – Class 8 – Coping and Behavior Change 1.5 CEs
9. March 9, 2023 – Class 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.

---

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

All hours earned count toward your CDCES Accreditation Information

---

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!

---

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.