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The Association of Diabetes Care and Education Specialists (ADCES) held its annual meeting once again in mid-August, the second time in as many years it’s hosted an all-virtual event due to the continuing COVID-19 pandemic.

Thousands of health professionals formerly known as diabetes educators came together online to hear about the latest in treatment and technology, and how they can best help people with diabetes (PWDs) in their own corners of the country.

By the numbers, it was an impressive showing for a virtual event like this, running Aug. 12 to 15, 2021:

  • More than 3,700 people attended, not including exhibitors and speakers. ADCES says the number of people who will be exposed to the content will continue to rise throughout the rest of the summer, given the sessions are available to online until Nov. 8, 2021 for professionals to access for continuing education credits.
  • 78 research posters in three categories: education, research, and emerging science from industry.
  • 119 presentations total, spread among 6 tracks:
    • Clinical and Self-Management Care Integration (27 sessions)
    • Diabetes and the Cardiometabolic Continuum (15 sessions)
    • Inclusive Person-Centered Care (19 sessions)
    • Levering Technology Devices, Data, and Patient-Generated Health Data (22 sessions)
    • Psychosocial/Behavioral Health (19 sessions)
    • The Business Side of Diabetes (16 sessions)

The conference’s overall theme for 2021 was “Changing Forward,” aimed at highlighting patient care that moves away from an institutional, “textbook” approach and toward more personalized care reflecting the diversity and specific needs of individual people with diabetes (PWDs).

Each of the four conference days also had a mini-theme:

“There were several valuable lessons that we learned from last year’s virtual conference, and this year we had the luxury of time and lots of experience in the virtual environment as compared to last year,” said Barbara Kocurek, the ADCES21 planning committee chair who is director of chronic care continuum at Baylor Scott & White Health in Texas. “Making the decision to have an all-virtual meeting was difficult, because networking is such a popular feature of this meeting.”

Kocurek said speakers had more time to prepare for presentations virtually and that improved the quality, and they also opened up the virtual conference platform a few days before the Thursday start to allow attendees to get familiar with it. All in all, she believes that advanced planning helped take this year’s conference to a higher level.

“There were several presentations to help elevate your role and articulate your value as a diabetes care and education specialist,” she said. “As ADCES President-elect Jan Kavookjian said in her keynote address, ‘Say it loud and say it proud, I am a Diabetes Care and Education Specialist!’ I want members to continue their great work in being champions for people with diabetes and advocates for equitable, accessible care.”

There are always a plethora of themes of keen interest to patients, but a few that caught the eye of our DiabetesMine team are recapped here.

Telehealth is here to stay beyond COVID-19

“Some of the topics were on lessons learned through the pandemic, the exciting world of telehealth, and how to continue to stay engaged in practice and sell ourselves and the amazing ways we can benefit people living with diabetes,” Julia Blanchette, CDCES (certified DCES) in Ohio, told DiabetesMine. “For the foreseeable future, I think virtual healthcare such as telehealth will continue to benefit people living with diabetes, it isn’t going away anytime soon.”

Other ADCES attendees echoed that sentiment, including longtime DCES Hope Warshaw in North Carolina, who said, “Diabetes care via digital health and telehealth is here to stay and will grow. Hybrid models of care may evolve, depending on coverage for digital and telehealth services by all providers and clinicians.”

What remains a problem, however, is that too few PWDs actually get sufficient education and support they need for their diabetes management. This has been a concern for many years, and it remains true that only about 7 percent of diagnosed PWDs get the proper education, according to several ADCES21 presenters. Diabetes Care Partners CEO Tony Song said he believes telehealth is a way to combat that problem, reaching more people in a different way beyond traditional in-person appointments.

Blanchette noted that the August 2020 conference was certainly more “COVID-19 and diabetes” heavy, which she found tough given the daily stresses of dealing with the pandemic personally and professionally. But for 2021, she found the content much more well-rounded.

Health inequities and bias

The issue of DEIA (Diversity, Equity, Inclusion, and Access) concerns came up in many different sessions and presentations at ADCES21, including the keynote by endocrinologist Dr. Joshua J. Joseph of Ohio State University’s Wexner Medical Center. He said the disparities are alarming, especially in the context of COVID-19 where PWDs experienced worse diabetes outcomes and had a higher risk of COVID-19 exposure, hospitalization, and death.

“We are all on this yellow brick road together where equity is our North Star,” he said in his presentation. “Unfortunately, oftentimes individuals do not think of equity at the beginning of their projects. We should think and act on equity at the beginning of any intervention for treatment and care that we do.”

This is of course a huge topic across society and healthcare right now, and DiabetesMine continues covering it as more research is done, and practical advice is generated to improve the situation for our community.

Diabetes technology on tap

There were of course numerous sessions devoted to the latest diabetes technology and data tools, along with how PWDs use these tools to help their diabetes management. Some of those included new smart insulin pen technology for those not on insulin pumps but who choose Multiple Daily Injection (MDI) therapy — from Medtronic’s InPen and Bigfoot Unity now available to the upcoming Lilly Tempo Smart Button in development.

There were also mentions and excitement over the upcoming Omnipod 5, Dexcom G7, Freestyle Libre 3, and the 180-day implantable Eversense XL CGM that are on the horizon before too long.

Warshaw said technology continues to be a big focus for diabetes care specialists, and the ADCES professional organization is working hard to arm their members in the best way possible. “DCES’s are becoming the diabetes devices and technology champions, helping people select, onboard, integrate, and optimize these into their lives with diabetes,” she said.

Back to school plans

The ADCES21 annual meeting always corresponds with the time of year that many schools and colleges across the United States are getting ready to start up instruction again. This was a big topic in some of the sessions focusing on pediatric diabetes, where experts delved into diabetes care as it relates to going back to school in a COVID-19 pandemic era.

In particular, Anastasia Albanese-O’Neill, PhD, RN, CDCES, in Florida, who is co-chair of the American Diabetes Association’s Safe at School program working group, said “we’re all still in the process of determining just how children with diabetes fared during the 2020-21 school year, and how the pandemic impacted their diabetes management during school. It’s tough because many were home learning virtually for quite a long time, and that change in routine impacted their management routines.”

She noted that at the start of the pandemic, they were seeing higher rates of diabetes ketoacidosis (DKA) in kids, likely as a result of delayed care from people not wanting to go to hospitals. DCES professionals have worked hard to share information about DKA and risk overall. Some families don’t have access to Internet or data plans, and so in-person education and diabetes care remain important.

But there was also a silver lining to the lockdowns, Albanese-O’Neill said: “One thing that hasn’t been noted as much is that people slowed down during the pandemic… that meant parents could observe their kids and their diabetes management more closely, and that led to higher outcomes that’s been documented in the literature.”

“Every child with diabetes is an individual, so planning for back-to-school is so important. You need a diabetes management plan,” she added. “Every child with diabetes is eligible for a 504 plan… specific to COVID-19, you’ll need to ask for additional accommodations, like a clean space for diabetes management — instead of maybe going to a clinic where a school nurse was as they did before.”

Cannibas (CBD) for diabetes complications?

Yes, this was a topic at ADCES21.

Cannabis and diabetes has long been a popular search item, sparking quite a bit of discussion and debate within the Diabetes Community. As laws have changed on this, the interest has grown in learning more about how medical marijuana, CBD oils, and gummies can be a part of diabetes management, or help with the diabetes complications front.

Dr. Kam Capoccia, a clinical professor at West New England University’s College of Pharmacy and Health Sciences, presented on this issue, noting that it’s important for anyone with heart, kidney, liver complications, or those who are pregnant not to use these products. She said it’s also not clear whether they have clinically significant benefit for PWDs who do use them. To date, the few studies touching on this aren’t large or conclusive enough to demonstrate certainty.

  • This 2020 clinical study involved 29 people with 62 percent being PWDs, using a topical CBD oil over the course of 4 weeks. It reduced intense and sharp pains along with cold and itchy sensations for all participants, according to their scores on the Neuropathic Pain Scale (NPS) that measures pain intensity.
  • An earlier clinical trial in 2016 involved 62 people with type 2 diabetes who don’t use insulin, finding that those taking a substance called THCV (also a nonpsychoactive phytocannabinoids derived from cannabis, like CBD) experienced decreased fasting glucose levels compared to those not taking it. Participants also showed improved beta cell function. But neither the THCV product nor CBD had any effects on cholesterol, heart function, weight, or appetite.

Capoccia emphasized that, as always, talking with a healthcare professional and keeping tabs on your own experiences through journaling are the best methods when curious about CBD or medical marijuana use for diabetes.

Kellie Antinori-Lent

“The general sessions on the first and last day of the conference were particularly enlightening and engaging, and reminded me of why I am in the field of diabetes care and education,” Blanchette in Ohio said.

“My biggest takeaway from the 2021 conference is diabetes care and education specialists have so much to offer, even during times like COVID-19 that pose barriers to access. We have to continue addressing barriers to access, and advocating for people with diabetes to receive diabetes care and education services.”

ADCES past president Kellie Antinori-Lent, a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center Shadyside Hospital, told DiabetesMine: “The overarching theme this year was bringing home the value of who we are and how to make it personal… and providing education specialists with the tools to do just that. It is so fulfilling to see the vision for the specialty, the new brand, and our new name be celebrated the way it should be… I couldn’t be more thrilled that ADCES21 was a success.”

Like the rest of the world, ADCES is closely watching the state of COVID-19 in the hopes that they can return to hosting in-person events soon. The tentative plan is to hold their next annual meeting in Baltimore from Aug. 12 to 15, 2022. DiabetesMine editor Amy Tenderich is thrilled to be a part of the planning committee for the tracts focused on diabetes technology.