By: Laurie Block, RDN, CDE. Edited by: Suvarna Sheth.
Diabetes management is changing rapidly. Every year, healthcare professionals and patients are introduced to new therapies, technologies and comprehensive care that is beneficial in making the management of diabetes easier.
Sometimes it’s hard to keep up with all the news and developments taking place in the field, whether you are a patient, have a loved one with diabetes, or a diabetes healthcare professional.
This special news round-up for 2019 is designed to give you a look at some of the notable diabetes news for 2019, in an easy to understand summary.
Round-Up 1: New Title for Diabetes Educators
In August of 2019, the American Association of Diabetes Educators (AADE) announced a title change for Diabetes Educators. The new title, “Diabetes Care and Education Specialist (DCES) is a general term for anyone working with diabetes.
It was a thought-out decision to reflect the wide range of responsibilities that are needed when caring for persons with diabetes.
The name reflects the concept that diabetes educators provide more than “teaching” and are involved in all aspects of medical management, psychosocial aspects, exercise, new advances in research and use and interpretation of technology.
The job title has changed to reflect that individuals in the field of diabetes are trusted experts and often part of the integrated care team that provides a collaborative comprehensive approach.
To understand the practice guidelines fully, take a look at the AADE standards for practice, available here.
Here are some key attributes of the new title:
- Who qualifies as a Diabetes Care and Education Specialist?
Any health professional that is already licensed as a Registered Nurse, Registered Dietitian/Nutritionist, Exercise Physiologist, Nurse Practitioner or Medical Doctor can be referred to as a Diabetes Care and Education Specialist (DCES). The title can also be used by other allied professionals or paraprofessionals working with diabetes.
- How is a Diabetes Care and Education Specialist Different from Being a Certified Diabetes Educator?
A Diabetes Care and Education Specialist (DCES) is not the same as a Certified Diabetes Educator (CDE).
A Certified Diabetes Educator (CDE) needs to be a licensed health professional plus sit for a comprehensive exam that is overseen by the National Certification Board for Diabetes Educators (NCDBE).
Eligibility to take the CDE Exam requires 1000 practice and clinical hours working specifically working with a diabetes population. Not all health professionals that have a strong background in diabetes sit for the CDE exam.
Qualification for the CDE Credential can be found at the National Certification Board for Diabetes Educators website.
- What does the name change mean for patients?
For families and individuals, this really is just a title change. Asking questions to health care providers about their past experience may better help to get a sense of formal education or practice hours.
It’s fair to say that all CDEs are Diabetes Care and Education Specialists, but not all Diabetes Care and Education Specialists are CDEs.
From my perspective, it is similar to saying anyone working in nutrition can use the term nutritionist, but not all nutritionists have passed an exam or put in the clinical experience to hold the title of a Registered Dietitian/Nutritionist (RDN).
There are many people working in the field of diabetes that have an excellent working knowledge of diabetes management and can truly be helpful to communities and individuals managing blood sugars. Peer related support and teachings with paraprofessionals can be very effective even though they do not hold a formal degree.
Round-Up 2: New Terminology for Target Blood Sugars
In June 2019, the American Diabetes Association announced updated recommendations for Time-in-Range Targets During Continuous Glucose Monitoring at the ADA’s Scientific Sessions in San Francisco, Calif.
Time in range (TIR) is a new concept that is helpful to individuals who use a continuous glucose monitoring device CGM.
TIR is the percentage of time an individual spends with their blood sugar levels in a specific target range. The ideal goal recommended is to keep blood sugar levels between 70- 180 mg/dl 70 % of the time.
This goal, of course, should be individualized but is a consistent goal to prevent complications related to diabetes.
This updated term reflects information that is available to those who use a CGM device. This monitor that detects as up to 300 readings per day, reflects glucose trends and provides significantly more data than traditional blood glucose fingersticks.
For this reason, new criteria and goals have been created.
- Why are the New Recommendations important?
TIR is important and recognizes the advances in blood glucose management and the importance of Continuous Glucose Monitoring.
The new recommendation provides an updated way of thinking about reaching blood glucose targets. The new recommendations were a consensus organized by the Advanced Technologies and Treatment for Diabetes Congress.
The international panel created a team of experts to suggest clinical targets that were reported at the ADA conference in June.
- How is Time in Range different than the Glycohemoglobin?
TIR is different than the Glycohemoglobin or A1C. TIR is a target goal aimed specifically for individuals who have extensive data from a CGM device.
With additional readings from a CGM, an individual can actually see the percentage of time they have in a specific target range.
The Glycohemoglobin or A1C provides a 2-3 month average of blood glucose, however, it does not take into account wide fluctuations in blood glucose or the blood glucose results pre and post meals.
The ADA therapeutic goal for A1 C results is less than 7 %; without experiencing excessive low blood sugar. A1C goals are easily translated into eAG, estimated average glucose levels. Check out this eAG/A1 C calculator.
It is important to know TIR, eAG and A1C goals all aim at keeping blood glucose levels in a healthy range and are aimed at decreasing the incidence of diabetes complications.
- Which organizations are adapting these Recommendations?
The recommendations are “unified recommendations,” which means the international consensus report was approved by the following groups: ADA, The American Association of Clinical Endocrinologists (AACE), American Association of Diabetes Educators (AADE), European Association for the Study of Diabetes (EASD), and Foundation of European Nurses in Diabetes (FEND), Juvenile Diabetes Research Foundation (JDRF), the Pediatric Endocrine Society (PES), and the International Society for Pediatric and Adolescent Diabetes (ISPAD).
Round-Up 3: New Treatment for Severe Hypoglycemia: Baqsimi a Nasal Glucagon
Image courtesy: Eli Lilly Company. https://www.baqsimi.com/
In June of this year, the U.S. Food and Drug Administration (FDA) approved Eli Lilly and Company’s BAQSIMI™ (glucagon) nasal powder 3 mg for the treatment of severe hypoglycemia in people with diabetes ages four years and above.
What is Glucagon? Glucagon is a hormone that helps the liver release stored glucose into the bloodstream. It is used to treat severe hypoglycemia and raises blood glucose quickly.
Until recently, glucagon was only available by injection. Glucagon administration is a critical emergency response treatment for hypoglycemia when a person is unconscious or unable to safely swallow a rapid-acting sugar source.
- How is injectable glucagon different than nasal glucagon?
Administering the injectable form of glucagon is a multistep process and is often challenging for caregivers. For many, administration with needles is more difficult than a single-use dispenser.
“Nasal glucagon seems to be easier to use and administer,” says Amy Jacobs RDN, LDN, CDE who is affiliated with Tallahassee Memorial Healthcare in Tallahassee, FL.
Jacobs clearly sees the value in new nasal insulin known as Baqsimi. “The severe-low glucose discussion with patients and families can be stressful,” she says. “When I bring out the ‘Glucagon Emergency Kit’ and when patients see the multiple steps involved, and the needle size, I sense an anxiety level increase,” she says.
With Baqsimi, Jacobs doesn’t see nearly the same level of anxiety. “Instead, my patients have a sense of, ‘I could do that.’
- Can Everyone use Nasal Glucagon?
Nasal glucagon is indicated for anyone with diabetes that is 4 years or older and does not have a history of liver disease, tumors in the pancreas or adrenal glands and is not allergic to glucagon.
It is effective in treating severe low blood glucose, easy to administer, compact, and portable with only a three-step process that simply requires inserting the tip of the device into one nostril and pushing a plunger. It does not require any active participation by the receiver.
Baqsimi has competitive pricing but as with many new pharmaceuticals on the market, it is important to inquire if insurance will cover the new nasal glucagon.
Round-Up 3: New Smart Insulin Pens On The Market
Image courtesy: Novo Nordisk. The NovoPen Echo.®
Insulin traditionally had been delivered with a vial of insulin and a syringe. In 1985, the insulin pen was introduced and revolutionized the way insulin was delivered.
The early pens were user-friendly and used a dial and dose technology to administer an insulin dose. Some pens used a prefilled cartridge while others were disposable. Either way, the pens were sanitary, improved accuracy in dosing, and helpful for the visually impaired.
“There have been recent advances with insulin pens,” says Catherine Moller, RN, CDE who is affiliated with Scripps Diabetes Care and Prevention Program in San Diego, Calif. “The newest smart reusable pens utilize Bluetooth technology along with bolus calculation features which pair to an app to support dosing decisions.”
In addition, Moller explains both insulin pen and CGM data can be viewed simultaneously making it easier to view trends and fine-tune management.
- What are the common pens that are available?
Inpen, NovoPen6, and the NovoPenEcho Plus, and the kid-friendly Echo Plus are available in the U.S. and select countries.
- What will the connectivity of the devices mean for users?
Technology and new devices can be a tremendous benefit for those who want to be proactive and are savvy enough to interpret all the information.
Smartpens have the ability to record past insulin doses, prevent insulin stacking and often are partnered with continuous glucose monitoring devices and other diabetes data management systems. This provides an electronic format to track insulin doses, blood glucose levels and fine-tune insulin management.
For many, technology can prove to be very useful, yet it’s important to understand that this new technology is not for everyone.
Traditional methods of managing blood sugars remain available and can be very effective. It is like buying a car with all the bells and whistles if you do not know how to use the features it may be too overwhelming.
Technology is not for everyone, is not age-related, and does not always translate to better management. There are many tools in the toolbox to effectively manage blood sugar levels with or without sophisticated technology.
- Are Smart Pens covered by Insurance?
Prior authorization is often needed when requesting new devices. It is important to discuss with your health care team your insurance benefits.
Your team can help advocate and or decipher if the new technology will be beneficial and help manage blood sugar levels easier.
Laurie Block RDN, CDE is a Registered Dietitian/Nutritionist who practices in New York City and La Jolla, Calif. She specializes in medical nutrition therapy with a special interest in diabetes, obesity, and cardiovascular risk factors. She is the author of the Type 1 Diabetes Cookbook published by Rockbridge Press and enjoys writing about nutrition-related topics. Block is passionate about helping kids, teens and adults reach their health care goals. She is involved in Marjorie’s Fund, a global initiative to empower adults living with Type 1 diabetes. She is also the co-founder of the Kids and Teens Healthy Weight Program at New York-Presbyterian/Weill Cornell Medicine.