Changes in 2022
In carbohydrates more emphasis was placed on ___
quality of carbohydrates.
Focus should be placed on high-quality, nutrient-dense carbohydrate sources that are high in fiber and minimally processed.
In accordance with the national standards for diabetes self-management education and support, all people with diabetes _____ participate in diabetes self-management education.
1. are recommended to
2. should
3. may
In accordance with the national standards for diabetes self management education and support, all people with diabetes should participate in diabetes self management education and receive the support needed to facilitate the knowledge, decision making, and skills mastery for diabetes self-care
Which diet approach has been proven to be consistently superior?
No single approach has been proven to be consistently superior, and more data are needed to identify and validate those meal plans that are optimal with respect to long-term outcomes and patient acceptability.
Name 3 behaviors we should be screening for in appointments outside of meals?
Consider screening for anxiety in people exhibiting anxiety or worries regarding diabetes complications, insulin administration, and taking of medications, as well as fear of hypoglycemia and/or hypoglycemia unawareness that interferes with self management behaviors, and in those who express fear, dread, or irrational thoughts and/or show anxiety symptoms such as avoidance behaviors, excessive repetitive behaviors, or social withdrawal.
How often should prolonged sitting be interrupted for optional blood glucose benefits?
Prolonged sitting should be interrupted every 30 min for blood glucose benefits.
New Fiber goal is ___ g of fiber
1. Minimum of 10 g
2. Minimum of 14 g
3. Minimum of 20 g
4. Minimum of 25 g
minimum of 14 g of fiber/1,000 kcal, with at least half of grain consumption being whole, intact grains, according to the Dietary Guidelines for Americans
There are four critical times to evaluate the need for diabetes self management education to promote skills acquisition in support of regimen implementation?
medical nutrition therapy
well-being: at diagnosis, annually and/or when not meeting treatment targets
when complicating factors develop (medical, physical, psychosocial)
when transitions in life and care occur.
What was emphasized as a healthy dietary pattern . . .
1. Carbohydrates
2. a whole
3. increase protein
Emphasize the importance of a healthy dietary pattern as a whole rather than focusing on individual nutrients, foods, or food groups, given that individuals rarely eat foods in isolation.
How often should we be screening for mental health?
Providers should consider annual screening of all patients with diabetes, especially those with a self reported history of depression, for depressive symptoms with age appropriate depression screening measures, recognizing that further evaluation will be necessary for individuals who have a positive screen.
What should the focus be for carbohydrates?
Focus should be placed on high-quality, nutrient-dense carbohydrate sources that are high in fiber and minimally processed.
Added Evidence on consumption of mixed meals, insulin dosing. Regarding fat and protein the studies have shown they _____ postprandial glycemia.
Studies have shown that dietary fat and protein can impact early and delayed postprandial glycemia
What are the 3 key goals of diabetes self-management education and support that should be measured as part of routine care.
Clinical outcomes
health status
well-being
are key goals of diabetes self management education and support that should be measured as part of routine care.
Research studies concluded what about low-carbohydrate meal plans for diabetics?
As research studies on low carbohydrate eating plans generally indicate challenges with long-term sustainability, it is important to reassess and individualize meal plan guidance regularly for those interested in this approach.
What additional mental health can be prevalent in patients with diabetes that we should be monitoring for?
The presence of symptoms or suspicions of disordered eating behavior, an eating disorder, or disrupted patterns of eating, should be monitored and evaluated for additional support
What does the evidence say about adjusting the protein intake?
There is no evidence that adjusting the daily level of protein intake (typically 1–1.5 g/kg body wt/day or 15–20% total calories) will improve health, and research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic management or cardiovascular disease risk.
Below the daily allowance of 0.8 g/kg is not recommended
Added to the “Diabetes Self-Management Education and Support”(DSMES) subsection to address digital coaching and digital self- management interviews as effective methods of education and support.
Technology-enabled diabetes self-management solutions _____ A1C.
Technology enabled diabetes self management solutions improve A1C most effectively when there is two-way communication between the patient and the health care team.
In a population that is in need of health care resources diabetic targets ________ health outcomes.
A randomized controlled trial (RCT) testing a decision making education and skill building program showed that addressing these diabetic targets improved health outcomes in a population in need of health care resources. Furthermore, following a DSMES curriculum improves quality of care
_________ importance can not be overemphasized?
1. individualized meal plan
2. carb counting
3. Physical activity
The importance of providing guidance on an individualized meal plan containing nutrient-dense foods, such as vegetables, fruits, legumes, dairy, lean sources of protein (including plant-based sources as well as lean meats, fish, and poultry), nuts, seeds, and whole grains, cannot be overemphasized, as well as guidance on achieving the desired energy deficit
What age should we be screening for cognitive impairment?
65 years
Consider screening older adults (aged 65 years) with diabetes for cognitive impairment and depression. Monitoring of cognitive capacity, i.e., the ability to actively engage in decision-making regarding regimen behaviors, is advised.
What supplement significantly lowered the risk of adverse cardiovascular events?
Supplementation with 4 g/day of pure Eicosapentaenoic acid (EPA) significantly lowered the risk of adverse cardiovascular events.
A new subsection on ____ has been added with recommendations for monitoring and referral for formal assessment, and a discussion of the evidence regarding cognitive impairment and diabetes.
Cognitive capacity should be monitored throughout the life span for all individuals with diabetes, particularly in those who have documented cognitive disabilities, those who experience severe hypoglycemia, very young children, and older adults
If cognitive capacity changes or appears to be suboptimal for provider patient decision making and/or behavioral self management, referral for a formal assessment should be considered.
DSMES helps people with diabetes to identify and implement effective self-management strategies and cope with diabetes at four critical time points
What are the four critical time points
At diagnosis
Annually and/or when not meeting treatment targets
When complicating factors (health conditions, physical limitations, emo- tional factors, or basic living needs) develop that influence self-manage- ment
When transitions in life and care occur
What was the most effective meal plan in improving A1C, particularly for individuals with an A1C between 7% and 10%?
1. a particular meal plan
2. two meal planning approaches
3. as many approaches as it takes
Two meal planning approaches were effective in helping achieve improved A1C, particularly for individuals with an A1C between 7% and 10%
Name the most common eating disorder associated with type 1 and for type 2 diabetics.
For people with type 1 diabetes, insulin omission causing glycosuria in order to lose weight is the most commonly reported disordered eating behavior, Diabulimia
Type 2 diabetes, bingeing (excessive food intake with an accompanying sense of loss of control) is most commonly reported.
For reimbursement, which avenue is not always reimbursed?
DSMES is frequently reimbursed when performed in person.
DSMES can also be provided via phone calls and tele-health, these remote versions may not always be reimbursed.