Diabetes medications are not just about glucose management anymore

In the past, to determine the right medication for an individual, the primary focus was placed on the glucose-lowering impact. However, with the introduction of the SGLT-2 Inhibitors and GLP-1 RA’s, there has been a tremendous leap forward and expansion of expectations for the co-benefits of diabetes medications.

The SGLT2s and GLP1’s, are both associated with weight loss without the fear of hypoglycemia. They decrease the risk of cardiovascular events and also offer renal protection. In addition, the SGLT-2s are so effective at treating heart failure (HF), that they are now being used for people with HF without diabetes.

Keeping close tabs on UACR and GFR

A big shift in determining the optimal diabetes treatment now includes thoughtful evaluation of Urinary Albumin Creatine Ratio (UACR) and GFR.

In the past, we collected UACR and GFR yearly to monitor kidney function. Now we use the results of these tests to determine not only kidney function but the risk of heart disease and the best therapy for diabetes, kidney health, and hypertension.

Now, more than ever, we are compelled to evaluate urinary labs to determine the albumin to creatinine ratio and keep a close eye on GFR to determine best practices to not only extend lifespan but improve healthspan.

For more info on UACR and GFR, see our blog post, “From Dipsticks to GFR – How to evaluate kidney function“.

PocketCards Update

Our updated Medication PocketCards reflect these shifts

In this latest version available for download and purchase, we have expanded and clarified the SGLT-2 considerations to reflect the changes in the 2022 ADA Standards of Care. We recognize that SGLT2 Inhibitors may be used as first-line therapy due to their additional benefits, “Along with metformin, SGLT-2s may be considered at first line diabetes therapy, especially for those with heart and kidney failure.” Since this class also slows the progression of chronic kidney disease, we also added, “for renal protection, use SGLT-2 Therapy if eGFR greater than or equal to 25 and UACR greater than or equal to 300.”

Since the GFR cut-offs for this med class are changing frequently, we removed the GFR guidelines for individual SGLT2’s and encourage users to review the package insert for the most recent recommendations.

Over the past twenty years, there has been tremendous expansion in the availability of diabetes medications that not only lower glucose but help decrease the progression of common diabetes co-comorbidities.  In this evolving medication landscape, our Medication PocketCards capture the critical and current information you need for your clinical practice and certification exams.

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Want to learn more about this topic?  Enroll in our

Meds Management for Type 2 Standards | 1.5 CEs

Recorded & Ready to Watch!

Coach Beverly will highlight the key elements of the latest Medication Guidelines by AACE and ADA. 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.

Objectives:

1. Describe the role of Diabetes Care and Education Specialists in stopping clinical inertia
2. Discuss using the latest ADA and AACE Guidelines to determine the best therapeutic approach.
3. Using the ADA and AACE Guidelines, describe strategies to initiate and adjust injectable therapy.

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Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer

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Two Registration Options

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

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Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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

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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.

• Experience decreased salivary production.
• Benefit from vinegar gargles to decrease bacterial load.
• At greater risk for oral cancers.
• More likely to experience tonsillitis.

Click Here to Test your Knowledge

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

Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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.

Happy April

If you want to get fired up about providing Diabetes Self-Management Education and Support (DSMES), I highly recommend reading the updated Standards for DSMES. If you don’t have time to read the complete document, we have provided our top 9 takeaways to get you started.

This new version of the DSMES Standards, authored by a collaboration of education specialists, offers a fresh outlook and a simplified six standards with the clear goal of increasing inclusivity and breaking down barriers.

In addition, we explore the expanding clinical applications of the SGLT-2 Inhibitor class.

Clearly, the newer diabetes medications are impacting more than glucose levels, they can also boast about co-benefits including cardiovascular and renal protection. We have updated our Med Pocket Cards to reflect this new perspective and considerations.

Our last two articles take a look at the concerning findings of increased risk of future diabetes post-COVID-19 infection. Large, controlled trials are saying the same thing, about 25-40% of people one year after experiencing COVID-19 are being diagnosed with new type 2 diabetes.

Lastly, to celebrate EARTH DAY, we pause, take a deep breath and notice the wonderment and gift of our beautiful planet. Research shows that planet health improves human health and decreases chronic diseases. Maybe we can each start with one action toward caring for our planet. We provide some great getting started resources on growing native plants in your backyard, patio, or veranda. All of our actions matter.

Beverly, Bryanna, Jackson, and Amanda

Featured Articles

• New DSMES Standard Changes. 9 Takeaways.
• Medication Pocketcard Updates for SGLT-2s
• COVID Increases Diabetes Risk? 
• Celebrating Earth Day
• Question of the Week
• Rationale of Week

Upcoming Webinars

• DiabetesEd Virtual Conference | April 13-15th
• Microvascular Complications| April 26th
• Critical Assess | April 28th
• Prep for BC-ADM | April 7th

Featured Items

• ADCES Book Bundle
• Free Resources

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

Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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.

For last week’s practice question, we quizzed test takers on which medications are needed. you all did great, since 81% of respondents chose the best answer. We want to 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 below: Answer Question

Question: LS is 43 with type 2 diabetes, with an A1C of 8.8%, UACR is 32 mg/g, GFR is 48, and blood pressure is 146/84 or greater on 2 different occasions.  Current medications include metformin 1000mg BID, lovastatin 20mg, glipizide 20mg.  

Based on the ADA standards of care, in addition to lifestyle encouragement, adding which medications would most improve outcomes?

Answer Choices:

• GLP-1 RA and low dose aspirin
• ACE and ARB for blood pressure management
• Basal insulin and a diuretic
• SGLT-2 and ACE or ARB

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As shown above, the most common choice was option 4, the second most common answer was option 1, then option 2, and then finally option 3.

Getting to the Best Answer

Answer 1 is incorrect. 7.61% chose this answer, “GLP-1 RA and low dose aspirin.” Since LS is under the age of 50 and their CV risk status isn’t revealed in this case study, we don’t have enough information to start LS on aspirin. We could consider adding a GLP-1 RA, since it is known to lower glucose, decrease CV risk and offer some renal protection. However, since one part of the answer is wrong, the whole answer is wrong, even though adding a GLP-1 to LS’s plan would be helpful.

Answer 2 is incorrect. 6.58% of you chose this answer, “ACE and ARB for blood pressure management.” LS does have hypertension and elevated albumin levels and is not taking any medication for blood pressure. Given those two risk factors, LS needs to take EITHER an ACE Inhibitor or ARB for blood pressure management, but NOT both. We would recommend starting LS on an ACE or ARB first and adjusting the dose based on home blood pressure reading. If LS needs an additional blood pressure medication, we could add a diuretic, calcium channel blocker or beta-blocker, or another agent. See our Hypertension & Lipids, Cheat Sheet for more info.

Answer 3 is incorrect. 4.94% of respondents chose this answer, “Basal insulin and a diuretic.” With an A1c of 8.8%, LS isn’t quite ready for insulin since there are 2 other medications we could try first (SGLT-2 or GLP-1) to get glucose to goal. The ADS Standards recommend trying a GLP-1 before basal insulin if possible to avoid the risk of hypoglycemia and to decrease weight gain. In addition, because LS has hypertension and albuminuria, a diuretic would not be the medication of choice to lower blood pressure. The preferred medications for blood pressure in the presence of albuminuria include either an ACE or ARB.

Finally, Answer 4 is correct. 80.86% chose this answer, “SGLT-2 and ACE or ARB.” GREAT JOB! Most of you chose this BEST answer. In the presence of hyperglycemia, albuminuria, and diminishing renal function, adding a SGLT-2 Inhibitor is the best choice based on ADA Standards. SGLT-2s have been shown to not only lower glucose and protect kidneys, they can also lower blood pressure due to their “glucoretic” properties. To manage LS’s hypertension, the preferred medications for blood pressure in the presence of albuminuria include either an ACE or ARB.

We hope you appreciate this week’s rationale! For more information on this topic, check out the ADA Standards of Care. Or, join our 3 day DiabetesEd Specialist Virtual Conference next week. It’s not to late to register!

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Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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.

If you want to get fired up about providing Diabetes Self Management and Education Support (DSMES), the newly updated Standards for DSMES is highly recommended reading. If you don’t have time to read the complete document, we have provided our top 9 takeaways to get you started.

Every 5 years, a committee of diabetes education specialists and advocates gets together to update this roadmap for the provision of DSMES. In the last version of this document, there were ten standards and lots of complicated rules and regulations required to set up a recognized DSMES Program.

In this new version, the collaborative of authors possesses a fresh outlook and clear vision that resulted in six simplified standards with the goal of inclusivity and breaking down barriers.

To address inequities, a candid discussion of racial disparities and social determinants of health is included. In addition, there is recognition that participation in DSMES has lost momentum during the pandemic with stagnant or decreasing enrollment. We need to innovate and make access and participation a top priority to make sure all people have the opportunity to benefit from this knowledge and life-saving information.

Coach Beverly’s 9 Takeaways from updated DSMES Standard.

1. I love the definition they included of a CDCES – “A compassionate teacher and expert who, as an integral member of the care team, provides collaborative, comprehensive, and person-centered care and education for people with diabetes”. This is the best description of our caring expertise and role in improving care.

2. DSMES makes a difference! – Lowers A1c by at least 0.6% with greater A1c reductions when engaging in DSMES of 10 hours or more.  In addition, DSMES has a positive effect on clinical, psychosocial, and behavioral aspects while improving quality of life and coping skills.  Individuals who participate are more likely to engage in self-care through behavior change, including eating healthier eating and regular exercise.

3. Breaking down barriers through recognition of Social Determinants of Health and addressing equity. The authors recognize the need for person-centered services that embrace cultural differences, social determinants of health, and ever-increasing technological engagement platforms and systems. The goal is to increase health equity through access to this critical service while focusing more on person-centered care and decreasing administrative complexities.

4. Recognition of the need for a thoughtful community needs assessment that looks at more than demographics. We still need to gain data from local and national resources to identify race, ethnicity, cultural background, sex, age, geographic location, tech access, and literacy. But just as important are the perceptions of risk associated with diabetes and barriers including socioeconomics, cultural factors, misaligned schedules, and health insurance shortfalls.

5. An important and often underappreciated barrier to DSMES includes perceived lack of need and limited encouragement from health care professionals to engage in DSMES. Plus, special attention needs to be payed to those who do not usually attend clinic appointments to discover their perceived and real barriers.

6. Diabetes Care Community Coordinators are needed to help build bridges between the medical community and the community we serve. These individuals include community health workers and health promoters who live in the community and have familiarity and understanding of the needs and cultural factors of the individuals we are seeking to serve. Diabetes care coordinators also include; dietetic technicians, medical assistants, peer educators, and leaders. They can instruct, reinforce self-management skills, support behavior change, facilitate group discussion and provide social support.

7. Keep the curriculum dynamic and practical. Research endorses the inclusion of practical, problem-solving approaches, collaborative care, consideration of psychosocial issues, and support of behavior change strategies to sustain self-management efforts. In addition, supplementing with resources and support materials can help individuals navigate the health care system and promote self-advocacy.

8. Strategies to increase DSMES participation through provider referrals. Keeping programs vibrant and active is no easy task and requires constant attention. I put together a list of strategies I have used to boost referrals by providers. Direct mail of DSMES flyers to providers, networking during community gatherings, lunch and learn CE activities, hallway conversations, welcome packet for new providers, delivery of referral forms and holiday gifts to offices, and shared participant testimonials.

9. Strategies to increase DSMES participation through self-referrals. We can directly appeal to our community members and then reach out to their providers to approve the referral f. Ideas to touch your community include; publishing articles on hot diabetes topics, sending out press releases, advertising in local papers and on social media, hosting events during National Diabetes Month, joining health fairs, providing community presentations to service organizations, and promoting word of mouth marketing with your graduates.

Diabetes Self-Management Education and Support is a critical components of comprehensive diabetes care. By addressing barriers and including community members in our outreach, we can break down the walls and increase participation and improve the quality of life for all people.

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Want to learn more about this topic? Enroll in our

Setting up a Successful DSME Program Standards Webinar | Level 2 $29 | 1.5 CEs

Recorded & Ready to Watch!

This course provides you with a succinct overview of the latest standards for Diabetes Self-Management Education (DSME) and Support Programs. If you are taking certification exams or considering setting up a DSME program, this program is designed for you. We highlight the newly revised and simplified 2022 Standards and provide strategies on program implementation. In addition, we discuss Medicare Reimbursement and covered benefits. This course provides insights into the exam philosophy and also highlights critical content areas.

Objectives:

1. Describe DSME program examples from across the country.
2. List the six standards for creating a successful DSME program
3. Discuss marketing strategies for success
4. Describe Medicare Reimbursement for diabetes care and education

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Join us for our Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

 Download Course Schedule |  Download Course Flyer

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

 Download Course Schedule |  Download Course Flyer

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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.

• 23
• 85
• 50
• 38

Click Here to Test your Knowledge

---

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

Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

---

Two Registration Options

---

Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

---

Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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.

For last week’s practice question, we quizzed test takers on the cause of JR’s leg pain. 67% of respondents chose the best answer. We want to 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 below: Answer Question

Question: JR is experiencing lower extremity pain and asks to get their gabapentin (Neurontin) renewed? When asked, JR says the pain is so bad in their calf muscles when walking, that they have to sit down and rest. What best describes the cause of JR’s pain?

Answer Choices:

• Loss of protective sensation (LOPS).
• Peripheral arterial disease (PAD).
• Autonomic neuropathy.
• Small nerve fiber neuropathy.

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As shown above, the most common choice was option 2, the second most common answer was option 3, then option 4, and then finally option 1.

Getting to the Best Answer

Answer 1 is incorrect. 4.72% chose this answer, “Loss of protective sensation (LOPS).” This is a juicy answer because people with neuropathy and loss of protective sensation are often prescribed gabapentin to treat nerve pain. However, when we learn that JR’s calf pain only occurs when walking, we experience an “ah-ha” moment.  The cause of JR’s pain is lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD).  The classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping.  Neuropathy is most often described as burning pain in lower extremities that is often worse at night.

Answer 2 is correct. 66.94% of you chose this answer, “Peripheral arterial disease (PAD).” JR is experiencing lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD).  A classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping. Perhaps JR was prescribed gabapentin due to an incomplete medical assessment. With this new information, we can collaborate with the provider to see if referral to a vascular specialist is warranted to evaluate if further intervention is needed.

Answer 3 is incorrect. 14.33% of respondents chose this answer, “Autonomic neuropathy.” Autonomic neuropathy in people with diabetes does not cause lower extremity pain.  Lower extremity pain is due to small and large nerve fiber destruction or peripheral arterial disease (PAD).  People with autonomic neuropathy and diabetes are at higher risk of gastroparesis, sexual dysfunction, resting tachycardia and a myriad of other conditions.

Finally, Answer 4 is incorrect. 14.01% chose this answer, “Small nerve fiber neuropathy.” This answer is tempting because people with small nerve fiber neuropathy are often prescribed gabapentin to treat nerve pain. However, when we learn that JR’s calf pain only occurs when walking, we experience an “ah-ha” moment.  The cause of JR’s pain is lack of arterial blood flow to the lower extremities, also known as peripheral arterial disease (PAD).  The classic symptom of PAD is pain in calf muscles or buttocks when walking that is relieved by stopping.  Small nerve fiber neuropathy is most often described as burning pain that is often worse at night. 

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 important learning activity!

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Want to learn more about this question? 

Watch our Lower Extremity Assessment Standards | Level 2
$29 for 1.5 CEs

Recorded & Ready to Watch!

People with diabetes are at increased risk of Lower Extremity Complications. This course reviews the steps involved in performing a detailed assessment of the lower extremities, including how to use a monofilament and tuning fork to detect neuropathy. We also discuss the significance of Ankle Brachial Index and strategies to prevent lower extremity complications.

Objectives:

1. Describe the risk factors for lower extremity complications
2. Discuss prevention strategies
3. Demonstrate steps involved in a lower extremity assessment

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Virtual DiabetesEd Specialist Conference
30+ CEs | April 13-15, 2022

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

 Download Course Schedule |  Download Course Flyer

If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Join us LIVE for this Virtual Course and enjoy a sense of community!

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

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Two Registration Options

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Virtual DiabetesEd Specialist Conference Deluxe | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Deluxe Version includes Syllabus, Standards and Swag*:

• Diabetes Educator Course 2022 Syllabus Hard Copy – over 100 pages -This spiral-bound workbook contains the printed version of all of the instructor’s slides.
• ADA 2022 Standards of Care Book -The ADA Standards of Medical Care in Diabetes is a key resource for healthcare professionals involved in diabetes care, education, and support.
• DiabetesEd Services highlighters, Medication PocketCard, Tote Bag and Pen

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Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

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

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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.

Having diabetes is a lot of work. We ask participants with diabetes to change their eating habits, drink water, move more, take a bunch of medications and attend diabetes classes plus see providers on a regular basis. In addition, we collaborate with and encourage them to get their ABC’s (A1C, Blood pressure, Cholesterol) to target.

Is worth all the work?

The short answer is YES. Making these hard fought behavior changes can add years to one’s life.

A recent study published in the JAMA Network last month suggests that people living with Type 2 Diabetes can increase life expectancy by reducing 4 risk factors and hitting specific metabolic targets.

This study evaluated life expectancy increases among 421 people living with type 2 diabetes for those who reduced A1C, systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) with each biometer goal was broken into quartiles.

A message of hope

Providers can shine a light on these findings to encourage people with diabetes to make those difficult behavior changes, and to keep working at it when the going gets tough. Their efforts do make a difference in improving life expectancy and daily quality of life.

Reducing A1C

Participants who reduced their A1C saw the highest increase in life expectancy compared to the other biometers. For those with the highest A1Cs, lowering their levels added years to their life expectancy.

• Fourth Quartile – The individuals who were able to bring their A1C’s down to 5.9% that started in the highest quartile at an average of 9.9% saw an average of 3.8 years added to their life expectancy.
• Third Quartile – Those who brought it down to 7.7% from 9.9% in the third quartile saw an average 3.4-year gain.
• Second Quartile – Participants in the second quartile with a change of 7.7% to 6.8% only saw a 0.5-year change in life expectancy.
• First Quartile – No change in life expectancy was seen for those in this quartile who went from a 6.8% HbA1c down to 5.9% HbA1c.

Lowering Systolic Blood Pressure

Lowering blood pressure added just over a year to the participant’s life expectancy.

• Fourth Quartile: The average baseline blood pressure was 160.4 mm Hg
• Third Quartile: Participants with a 139.1 mm Hg saw 1.1 years gained in life expectancy.
• Second Quartile: A 128.2 mm Hg was associated with a 1.5-year gain in life expectancy.
• First Quartile: The highest increase in life expectancy for blood pressure was for those at 114.1 mm Hg with a 1.9 year gain.

Lowering LDL Cholesterol

Participants with lower LDL cholesterol, saw a change in life expectancy by a few months.

• Fourth Quartile: The baseline was 146.2 mg/dL.
• Third Quartile: Those who had a 107.0 mg/dL saw a half-year increase in life expectancy.
• Second Quartile: Those who had an 84.0 mg/dL saw a 0.7 year gain in life expectancy.
• First Quartile: Individuals who had a 59 mg/dL saw a 0.9-year gain in life expectancy.

Lowering Body Mass Index

Participants who were able to decrease their BMI saw a increased life expectancy by a few years.

• Fourth Quartile: The baseline BMI was 41.4 (fourth quartile) with the lower three quartiles seeing a change in life expectancy.
• Third Quartile: For individuals with a BMI of 33.0, they saw an additional 2 years of life expectancy
• Second Quartile: Those who had a BMI of 28.6 saw an additional 2.9 years of life expectancy
• First Quartile: Those living with Type 2 with a BMI of 24.3 see an additional 3.9 years of life expectancy

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Smoking cessation also had an impact with 0.7 years added for women aged 50 to 60 years and 1.1 years for men aged 70 to 80 years of age.

Overall, we hope this news brings hope to those living with Type 2 diabetes and improves care knowing that reaching these goals can extend their lifetime.

To read more click here and here.

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Join us live next Tuesday and Thursday as we continue our Level 2 – Standards of Care Intensive live updates! Read more and enroll below.

 

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.