Written by Monique Jackson, MSN, CFNP, WHCNP, CDCES

A new study finds that hemoglobinopathies may distort A1C accuracy for people of African descent living with diabetes.  

African Americans at risk for falsely low A1cs due to Hemoglobin Variants

Hemoglobin variants don’t increase the risk for diabetes, but it can affect the results of A1C tests.  African Americans Heterozygous for the common hemoglobin variant HbS may have, for any given level of mean glycemia, lower A1C by about 0.3% then those without the trait.  Another genetic variant, X-linked glucose-6-phosphate dehydrogenase G202A, carried by 11% of African Americans, was associated with a decrease in A1C of about 0.8% in homozygous men and 0.7% in homozygous women compared with those without the variant  (American Diabetes Association, Standards of Care in Diabetes-2021; 16). 

 Health care professionals often use A1C test results to guide decisions about diabetes care, such as changes to medication, meal plan, or physical activity routine to manage diabetes.  In those with certain hemoglobin variants, A1C is not accurate for diagnosing and managing diabetes.  Different tests that accurately reflect long term glucose levels are needed for early diagnosis and to provide needed medical management that prevents complications. 

Mismatch between Glucose and A1c –  My Clinical Finding

At my clinic, where I work as a Diabetes Nurse Specialist, an African American individual arrived with a high random glucose and mildly abnormal A1C.  Reviewing their lab work, I noticed that the random blood glucose was 300 mg/dl and the A1C was at approximately 7.0%.  When I converted the A1C to average blood glucose and compared with the elevated reading in the logs, the numbers did not match up. I realized that this individual had one of the hemoglobin variants (Sickle Cell anemia) HbS.   I ended up starting them on Metformin for blood sugar, Atorvastatin because of the guidelines that everyone with Diabetes should be on a statin, Aspirin to prevent heart attack, and Lisinopril for blood pressure control. 

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Without this clinical finding that the elevated blood sugars were not reflected in the A1c, this individual might not have been started on diabetes treatment, because of the false low A1C.

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A1C reflects glucose concentration from the past 2-3 months, but this relationship may differ between those with nutritional deficiencies, anemia, or genetic hemoglobinopathies, including the Sickle cell trait.

Since A1C measures the percentage of glycosylated hemoglobin, individuals who possess variants of hemoglobin can exhibit falsely low readings.  

Fructosamine testing, which evaluates albumin glycosylation for the past 2-3 weeks, may be a better measure to help people with diabetes monitor and manage their blood glucose levels in cases where the A1C test cannot be used and/or a short-term monitoring window is desired.    

Summary and Notes for the Future

It is important to consider the results of the A1C, fasting blood glucose, two-hour glucose tolerance test, random blood glucose, and or fructosamine when you are screening someone with diabetes who is diagnosed with a Hemoglobin variant.  

A1C testing on two different occasions to diagnose diabetes for those with Hbs variants is not recommended, because it will yield false low results.  To diagnose a person with diabetes and Hbs variants, the ADA recommends only plasma blood glucose criteria be used to diagnose diabetes.

More research is needed on the diagnoses of diabetes utilizing the A1C in populations with increased prevalence of Hbs variants.  In addition, we need research aimed toward providing more accurate tests for the diagnosis and management of conditions associated with increased red blood cells turnover, such as sickle cell disease, hemoglobinopathy variants, pregnancy (second and third trimester).  

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Welcome, Monique Jackson, MSN, CFNP, WHCNP, CDCES, our new Blog Content Writer!

We are so excited to introduce our newest DiabetesEd Specialist Blog Contributor, Monique Jackson, MSN, CFNP, WHNP, CDCES.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

1. Glucose targets are based on the individual.
2. Strive to achieve at least 80% time in range.
3. A1C less than 6.5% for children under the age of 18.
4. Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.

Click here to test your knowledge!

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Level 2 | From Tots to Teens Diabetes Standards | 1.5 CEs

We discuss the clinical presentation of diabetes, goals of care, and normal growth and development through the early years through adolescence. Strategies to prevent acute and long term complications are included with an emphasis on positive coping for family and child with diabetes.

Topics include:

• Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes
• State Strategies to prevent acute and chronic complications
• Discuss the importance of positive psychosocial adjustment and resources

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

For our June 1st Question of the Week, only 45% of respondents chose the best answer. We want to “take a closer look” at this question and figure out how to drill down to discover the best response.

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 43 years old with newly discovered type 2 diabetes. 

According to the ADA Standards, which of the following actions need to be taken with a new type 2 diabetes diagnosis?  

Answer Choices:

1. Hepatitis B Vaccine.
2. Screening for prostate cancer.
3. Referral to podiatry.
4. Antibody testing to confirm the diagnosis.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with preventive care measures, especially suggested vaccinations based on age and risk profile.

Answers & Rationale

Answer 1 is correct, 45.48% chose this answer, “Hepatitis B Vaccine.” CONGRATS, this is the BEST answer. According to the ADA Standards of Care (see below), people with diabetes who are 18-59 years of age need protection against hepatitis infection. Since people with diabetes may share glucose checking devices and may have less hearty immune systems, they are at higher risk of getting Hepatitis B. Getting the 2-3 dose series if not previously vaccinated, offers important protection.

Answer 2 is incorrect, 4.68% of you chose this answer, “Screening for prostate cancer.” According to the ADA Standards, a new diagnosis of type 2 diabetes does not require screening for prostate cancer. In addition, according to the consensus statement on Diabetes and Cancer, men with diabetes are not at higher risk of prostate cancer. However, people with diabetes are at higher risk of pancreas, liver and breast cancer, so regular screenings for these types of cancers is indicated.

Answer 3 is incorrect, 26.61% of you chose this answer, “Referral to podiatry.” This is answer is juicy, but we don’t have enough details in the question to support referral to a podiatrist. Not everyone with new diabetes is referred to podiatry for lower extremity care. Podiatry referral is based on a careful lower extremity assessment coupled with an indication that this person is at higher risk of complications (ie ulcerations, severe calluses, risk of injury when cutting toenails, loss of protective sensation, etc).

Answer 4 is incorrect, 23.23% of you chose this answer, “Antibody testing to confirm the diagnosis.” Another juicy answer. For most people with new type 2 diabetes, the clinical presentation coupled with family history and ketone status is usually enough to determine the type of diabetes. If the question hinted that this person might have type 1 (ie history of celiac or thyroid disease, positive ketones, BMI of 21 etc) then, the provider may want to evaluate for the presence of antibodies.

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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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

For our June 15th Question of the Week, only 54% of respondents chose the best answer. We want to “take a closer look” at this question with the aim for 100% correct responses the next to go around.

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: RT is 12 years old and has a new diagnosis of type 1 diabetes.

Based on the ADA Standards of Care, what is the most accurate statement regarding glycemic goals?

Answer Choices:

1. Glucose targets are based on the individual.
2. Strive to achieve at least 80% time in range.
3. A1C less than 6.5% for children under the age of 18.
4. Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with the goals of care for specialty populations, including pediatrics.

Answers & Rationale

Answer 1 is Correct, 54.26% chose this answer, “Glucose targets are based on the individual.” GREAT JOB. This is the best answer. The American Diabetes Association provides a general A1c target of 7% or less for pediatrics, but it encourages the person with diabetes and the care provider to determine glucose ranges that best match the individual based on their values, preferences, access to technology and safety.

Answer 2 is incorrect, 15.06% of you chose this answer, “Strive to achieve at least 80% time in range.” According the the ADA, the time in range target is 60% or an A1c of less than 7.5% for those under the age of 25. Of course, these goals are customized to match the individual.

Answer 3 is incorrect, 11.07% of you chose this answer, “A1C less than 6.5% for children under the age of 18..” This is a juicy answer. This target may be right for those who are using a CGM, pump and advanced technology features that help users avoid hypoglycemic events. But this is not the A1C target for all children with type 1 diabetes, so this is not the best answer. There is no A1C target that fits all.

Answer 4 is incorrect, 19.60% of you chose this answer, “Pre-meal glucose of 80-130 and post-meal glucose less than 200 to prevent hypoglycemia.” The American Diabetes Association provides a general A1c target of 7% or less for pediatrics, but it encourages the person with diabetes and the care provider to determine pre and post meal glucose ranges that best match the individual based on their values, preferences, access to technology and safety.

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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Want to learn more about this topic? Enroll in our

Level 2 | From Tots to Teens Diabetes Standards | 1.5 CEs

We discuss the clinical presentation of diabetes, goals of care, and normal growth and development through the early years through adolescence. Strategies to prevent acute and long term complications are included with an emphasis on positive coping for family and child with diabetes.

Topics include:

• Discuss the goals of care for Type 1 and Type 2 Kids with Diabetes
• State Strategies to prevent acute and chronic complications
• Discuss the importance of positive psychosocial adjustment and resources

---

See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Which of the following is an accurate statement regarding diabetes and cancer?

1. People with diabetes have a slightly lower risk of liver and uterine cancers.
2. Some brands of metformin were recalled because of an NDMA impurity, so it is best to hold metformin for now.
3. There is research suggesting that metformin may be associated with a decreased risk of certain cancers.
4. Metformin does not increase the risk of cancer, but it can negatively impact renal function.

Click here to test your knowledge!

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Level 4 | Cancer & Diabetes | 1.25 CEs

Topics Include:

• Discuss the relationship between cancer, hyperglycemia and insulin resistance.
• State 3 benefits of normalizing glucose levels during chemotherapy.
• Using a case study approach, discuss strategies to improve glucose levels and quality of life.

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See Full Calendar for upcoming webinars and Virtual Courses.

Can’t make it live? All paid registrants are guaranteed access to the video presentation, handouts and podcasts.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

June eNews  | DiabetesEd Scholarships & 7 Reasons for Gratitude

Happy June!

Coach Beverly is feeling grateful

For this newsletter, I am practicing my gratitude out loud and sharing it with you all.

Here are 7 things I am grateful for:

1. My birthday is in early June.
2. June kicks off Pride Month.
3. We welcome a new team member and blog contributor, Monique Jackson.
4. A new glucagon treatment is available, with updated Glucagon Cards you can download for FREE or check out on our CDCES Coach app.
5. We are holding our first LIVE DiabetesEd Specialist Course in San Diego in over a year, which will include; Diabetes Flash Mob, DiaBingo, Prizes, fantastic meals, networking, laughing, and learning together.
6. There are 2 scholarships available for our Diabetes Ed Live Seminar.
7. Lastly, I am deeply grateful for my remarkable family, friends, my Diabetes Ed Team, all of YOU, and this opportunity to live and contribute every day.

In this newsletter, we address topics ranging from hemoglobinopathies to inclusion to new glucagon meds.

Bryanna and I had a lot of fun putting this newsletter together because it rings so true to the mission of our company; to be inclusive and welcoming, to celebrate each individual while leaving judgment behind. To lift each other up, especially during hard times. To offer hope, promote curiosity, and let you always know that we believe in you.

Happy June everyone,

Coach Beverly, Bryanna, and Jackson

Click here to read our full June 2021 newsletter.

Featured Blogs

• Theresa Garnero on Inclusive Practices for LGBTQ+ community
• African American’s at Risk for falsely low A1Cs
• Meet Monique Jackson, new blog contributor
• New Glucagon Rescue Med
• Rationale of the Week
• Question of the Week
• 2 Scholarships Available

Featured Items

• Live Seminar in San Diego
• Live Webinar Updates
• Preparing for CDCES FREE Webinar – July 8th
• Preparing for BC-ADM FREE Webinar – July 15th
• On Sale: ADA Standards of Care Book
• Free Resources Catalog

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

For our May 25th Question of the Week, 71% of respondents chose the best answer, which is awesome! However, for safety and teaching purposes, we still want to “take a closer look” at this question at aim for 100% correct responses the next go around.

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: Mr. J is started on 100 units U-500 twice a day.

Which of the following administration techniques would ensure he gets the right dose?

Answer Choices:

1. Using a U-100 syringe, withdraw 100 units.
2. Using a U-500 syringe, withdraw 20 units.
3. Using a U-500 pen, dial to 100 units.
4. Using a U-500 pen, covert to 20 units.

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

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with accurate dispensing of diabetes medications, injectables and insulins, including the concentrated versions.

Answers & Rationale

Answer 1 is incorrect, 7.11% chose this answer, “Using a U-100 syringe, withdraw 100 units.” This answer is wrong because when withdrawing U-500 insulin from a vial, a U-500 insulin syringe must be used (see image). Since U-500 insulin is 5x’s the concentration of U-100 insulin, drawing up 100 units of U-500 insulin in a U-100 syringe would deliver 500 units of insulin (or 5x’s too much and could be life threatening). See Concentrated insulin card below.

When using a U-500 syringe, no conversion is needed since the syringe automatically delivers the correct dose of U-500 insulin. No conversion, calculations or adjustments required.

Answer 2 is incorrect, 12.64% of you chose this answer, “Using a U-500 syringe, withdraw 20 units.” When using a U-500 syringe, no conversion is needed since the syringe automatically delivers the correct dose of U-500 insulin. No conversion, calculations or adjustments required. For example, if the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 syringe, the person would withdraw 100 units of U-500 insulin.

Answer 3 is correct, 71.25% of you chose this answer, “Using a U-500 pen, dial to 100 units.” YES, GREAT JOB! If the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 pen, the person would dial to 100 units of U-500 insulin. The pens automatically deliver the correct dose in less volume. No conversion, calculations or adjustments required.

Answer 4 is incorrect, 9.00% of you chose this answer, “Using a U-500 pen, covert to 20 units.” When using a U-500 pen, no conversion is needed since the U-500 pen is specifically created to deliver the correct dose of U-500 insulin. For example, if the order reads “100 units of U-500 concentrated insulin twice a day”, using a U-500 pen, the person would dial to 100 units of U-500 insulin.

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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Want to learn more? Enroll in our

Brand New Online Advanced Courses | Level 4!

We are so excited to expand our Level 4 – Advanced Level & Specialty Topics Series!

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!

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

June is Pride Month and in honor of providing best care for our LGBTQ+ community, we are highlighting an expert interview, with my dear friend and colleague, Theresa Garnero, APRN, BC-ADM, MSN, CDCES.

Theresa is a trailblazer and advocate in the field and she reminds us that whether we provide services in the hospital, clinic, or outpatient settings, we can take steps to help all people we serve feel welcome and included. We know that many people from the LGBTQ+ community with prediabetes or diabetes may delay seeking medical care to avoid the pain of social stigma often experienced in medical settings.

“Members of the lesbian, gay, bisexual, transgender and queer (LGBTQ) community have unique health disparities and worse health outcomes than their heterosexual counterparts, which has clinical relevance in the delivery of diabetes care and education. Diabetes care and education specialists are in a pivotal position to help this medically-underserved and vulnerable population get the best possible care.” – ADCES

By paying careful attention to each person’s experience from the moment they walk in the door until we say goodbye, we can find ways to create a more inclusive environment. This awareness of the details, such as inclusive gender questions on intake forms or gender-neutral signage on the bathrooms, are great first steps to show your care and respect for those you work with.

For more information on this topic, we turn to our expert for insights and resources.

Interview with Ms. Theresa Garnero, APRN, BC-ADM, MSN, CDCES

1. What inspired you to write the ground-breaking article for on “Providing Culturally Sensitive Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) community” in Diabetes Spectrum, gosh – already 10 years ago now?

I heard a researcher at a national conference go on and on about needing to screen the daughters of women with polycystic ovarian syndrome (PCOS) for diabetes since there is a strong link between PCOS and type 2. She never discussed the population of women that have the highest rates of PCOS – lesbians (38% of lesbians have PCOS vs. 14% of heterosexual women¹). So I went up to the mic and asked her if she was aware of Agrawal’s work showing lesbians have the highest rate of PCOS. I was flabbergasted when she said yes. I responded she might want to include that most vulnerable population in her talk as we need to screen all women at risk.

It got me thinking about how could a well-known professor at a national diabetes conference willingly withhold data about an under-served population? So, I began to comb through the existing research that impacts the LGBTQ community with regards to diabetes care and prevention. And I was astonished what I found. So, I wrote the article and was so glad the ADA published it. But why wasn’t this part of the conversation back then? Even now? And I still ask, why won’t ADA reply to my inquiries to include this special population within their Standards of Care?

2. What’s the first step our readers could do to provide inclusive care to the sexual and gender minority population of people with prediabetes and diabetes who seek care?

Actually take steps to include this special population. I think there are several opportunities to do this, starting with making sure their environment gives clues that it is a safe place for the LGBTQ community to seek care. Remember, this community is used to outright hostility from within the healthcare system and are often reluctant to self-disclose out of fear for getting substandard care.  I once worked with a man with type 1 diabetes who was gay tell me that his endocrinologist told him he deserved every low he got, and that when he’d go to the emergency department, they refused for his husband to be by his side And that happened in the gay mecca of San Francisco! Imagine other “less tolerant” places.

If they see you don’t have a clue because you have old forms with old terms, they most likely won’t come out. And if they don’t come out, then you don’t have all the data to make an individualized plan. So, you can check your assessment forms to see if you use inclusive terms. Do you actually ask for LGBTQ status by asking for sexual orientation, gender identification and relationship status (not marital status)? And collect the aggregate data! Just because it’s not measured doesn’t mean it doesn’t exist. Do you have clues in your waiting room that it’s safe and friendly for this group (like post a little rainbow flag)? Do you include LGBTQ risk factors for health outcomes in your materials? Do you tell people you are here to help everyone, no matter their situation or who they’re with? I realize change is slow, but collectively as individuals, and nationally, we can make it a better place for this underserved population.

3. “Inclusive Care” seems to be the new buzz phrase, but I bet most diabetes care and education specialist think they are being inclusive. I mean, how could you not be?

Because if you don’t even know a certain segment of those you care for have unique risk factors, and arguably worse – you have no clue who that vulnerable population is in your practice – you aren’t doing all you can to provide quality care to all you serve. It’s estimated that the number of LGBTQ individuals with diabetes equals that of the amount of people with type 1, so it’s not a small number we’re talking about. As an example, let’s apply this to Social Determinants of Health. We talk about the research showing how your zip code has more to do with your health than your DNA, particularly as it relates to food insecurity. But did you know LGBTQ individuals and families have the highest rates of food insecurity? Why isn’t that research included in diabetes mainstream publications and conferences?

According to research presented by the Williams Institute², more than 1 in 4 LGBTQ adults (27%), approximately 2.2 million people, experienced a time in the last year when they did not have enough money to feed themselves or their families, compared to 17% of non-LGBTQ adults.

And when you add racial/ethnic sub-populations within the LGBTQ community, the stats are staggering:

• Among LGBTQ people, 42% of African-Americans, 33% of Hispanics, 32% of American Indians and Alaskan Natives, and 21% of Whites reported not having enough money for food in the past year.

4. I was thrilled to see the handout that you wrote about inclusive care for the ADCES. That’s a start for sure. How do you think this came about?

Thank you! I am so excited to see our national organization pay attention to the LGBTQ population and help get the word out about what we can do. I think because they are interested in us being the best diabetes care and education specialist that we can and including everyone is part of that. I had also just spoken at the AADE conference in Houston. We had a panel of professionals and researchers that represented the LGBTQ community. (I had spoken previously at AADE, but that was just by myself and this last time was so special.) I’m truly impressed with how much research that has transpired in these 10 years.

5. Any closing thoughts?

I’d say that a willingness to learn is so important. As is recognizing one’s personal biases. We certainly don’t agree with the lifestyles of all we serve, but it is not our role to judge or let those biases interfere with helping someone find a path to thriving with diabetes. And just know, it takes time to get up to speed. I’d encourage readers to check out the ADCES handout and watch this funny video clip that a colleague sent me. Honestly, it is hard to keep up with the terms, even for someone like me who helped to get this topic on the diabetes radar. This video made me crack up and appreciate the nuance of all the terms. I bet your audience would like it too. You can check out the “What “The Sex Talk” Looks Like Now, by Alternatino. Thanks so much, Beverly, for your willingness to discuss the topic. I truly hope it helps your readers improve their care delivery.

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Ms. Theresa Garnero, APRN, BC-ADM, MSN, CDCES  trail-blazed several innovations in the field of diabetes in the years that followed being awarded the national Diabetes Educator of the Year by the American Association of Diabetes Educators (2004).

Her latest efforts involve trying to reach people with prediabetes and type 2 who are currently not being reached with our face-to-face programs. How? She created the Sweet People Club  an all online program which uses a flipped classroom concept so people can follow the Diabetes Prevention Program and also manage type 2 through a series of professionally-made videos (ahem, nearly 150 of them!) that they can watch at a time that is convenient for them, then ask questions through the portal, as well as meet virtually face-to-face real time with a Registered Dietitian twice a month.

If you’d like access to experience what the program is like, she is sharing her work and invites your feedback. Visit https://www.sweetpeopleclub.com/pro/ or email her for questions at [email protected] 

List of Resources

ADCES Inclusive Care for LGBTQ+ People with Diabetes Handout – this handout provides definitions, terms to avoid, and a cultural competency checklist to help you move towards improving inclusivity within your practice.

All Gender Restroom Sign PDF

A Guide To Gender Identity Terms by NPR – A glossary for gender identity terms to use more inclusive language.

Diabetes Prevention and Management for LGBTQ+ People Handout – this handout includes research of diabetes within the LGBTQ community, along with clinical considerations, programs, and resources for diabetes educators to use within their practice.

Policies on Lesbian, Gay, Bisexual, Transgender & Queer (LGBTQ+) issues – this resource by the American Medical Association lists all the current healthcare policies in place for the LGBTQ community.

Helio’s LGBTQ+ Health Updates Resource Center – this is a “collection of news articles and features that provide the latest information on the unique health needs of individuals in the LGBTQ+ community.”

1. Agrawal et al: Prev. of polycystic ovaries and polycystic ovary syndrome in lesbian women compared w heterosexual women. Fert Steril 82:1352-57, 2004.
2. FOOD INSECURITY AND SNAP PARTICIPATION IN THE LGBT COMMUNITY. (n.d.).
3. Sweet People Club

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