OTCE 2019-2020 Subscription

Each day in the U.S., 10,000 baby boomers celebrate their 65th birthdays. One in five Americans will be over the age of 65 by 2030 and 10% of the population will be over the age of 90 in 2050. While the literature routinely specifies those over the age of 65 as "older" adults, this population is complex and varies greatly in terms of health status, duration and type of diabetes, physical and mental ability, financial situation, preferences, cultural values and barriers to care.

You may encounter a frail 68 year old who resides in long-term care today and then tomorrow you might see an 88 year old who is asking for help with adjusting meal times and insulin administration during overseas travel through multiple time zones. Many will have fixed incomes and approximately 1 out of 3 will live alone which can put them at risk for malnutrition, food insecurity and depression. Others will still be working, enjoying great family or community support, and have the desire and motivation to fully participate in self-care for optimum quality of life.

Diabetes management is a complex process and cognitive declines that come with aging will necessitate changes in care plans and delivery of self-management instruction. As healthcare providers, we should be mindful of these issues and do our best to honor and empathize with the challenges faced by older adults.

This issue discusses using validated assessment tools and evidence-based guidelines to inform treatment and improve individualized care for older adults living with diabetes.

CPE: 4.0
CPE Level: 2

On the Cutting Edge: Continuous Glucose Monitors and Digital Health (Vol 40, No 4)

The articles in this issue are meant to empower nutrition professionals to become advocates for CGM and to play leading roles in CGM implementation, data translation, and reimbursement.

CPE: 4.0
CPE Level: 2

Sandi Spicer-Moore, MA, RD, LD, CDE, BC-ADM sets the stage with her article, Integrating CGM Into Your Practice. Not only did she include the types of CGM products available and their resources, but she also touched upon the differences between personal and professional use CGM, along with billing codes that can be used by the healthcare professional for reimbursement.

CGM is complex and includes a plethora of new terms. Lynne Lyons, MPH, RD, CDE covers Continuous Glucose Monitoring Data Interpretation for Clinicians, by giving key information to deconstruct a standardized report, the downloaded CGM data, as well as crucial questions to ask while viewing the reports with patients to further empower them to understand their glucose trends.

Dana Gershenoff, MS, RD, CDE and Holly Willis, PhD, RDN, LD dive in to cover Clinical Applications of CGM for individuals with T2D Not Using Intensive Insulin Therapy. They cover a lot of ground, giving the reader some useful open-ended questions to consider when educating a CGM user. They also highlight the use of making suggested treatment adjustments with CGM based on food, activity and medications.

Amy Hess Fischl, MS, RDN, LDN, BCADM, CDE builds on the previous article to cover Clinical Applications of CGM for People Using Multiple Daily Injections (MDI) and Continuous Subcutaneous Insulin Infusion (CSII), including practical tips for pattern management and case studies designed to stimulate further thinking.

This issue would not be complete without a thorough understanding of digital tools, connected diabetes devices, software and other digital health tools that can be used in conjunction with diabetes self-management education and support. Janice MacLeod, MA, RD, CDE, FAADE covers Data Driven Diabetes Care and Education Services explaining the options available and how they can be integrated into nutrition care.

Laurie Ann Scher, MS, RD, CDE focuses her article on Apps for Diabetes Care and Management giving a high-level overview of how to choose appropriate apps that are safe and effective along with a table of specific apps to consider when working with people with diabetes (PWD).