CEimpact Podcast

ADA 2025 Diabetes Guidelines Non-Glycemic Parameters

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Explore the ADA 2025 Diabetes Guideline updates from a different lens – one focused on non-glycemic parameters like cardiovascular health, kidney protection, and weight management. This episode highlights evidence-based recommendations to equip pharmacists with the necessary knowledge to take a more holistic approach to patient care. Listen and discover how to integrate these key updates into your practice to improve outcomes beyond glycemic control.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Justinne Guyton, PharmD, BCACP
Associate Professor of Pharmacy Practice
University of Health Sciences and Pharmacy 

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify three key non-glycemic updates in the ADA 2025 Diabetes Guidelines.
2. Explain the pharmacists role in addressing non-glycemic parameters in diabetes care.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-030-H01-P
Initial release date: 2/10/2025
Expiration date: 2/10/2026
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and, as always, I'm super excited about our conversation today. Diabetes care is evolving beyond glucose control. The ADA 2025 guidelines emphasize non-glycemic factors like cardiovascular health, kidney protection and weight management. In this episode, we'll explore these critical updates and how pharmacists can take the lead in delivering holistic care that improves outcomes for patients with diabetes. And it's so great to have Justine Guyton as our guest expert for this episode. Welcome, justine. Thanks for joining us.

Speaker 2:

Thank you so much for having me.

Speaker 1:

Absolutely so. If you don't mind for our learners, just give a little bit of background for yourself, maybe your practice site and why you're passionate about diabetes care.

Speaker 2:

Sure, I am an ambulatory care pharmacist by training and I practice at the St Louis County Department of Public Health and so we're a primary care clinic. One of the other lenses in my practice there is it's mostly an underinsured population, so we have a lot of patients that have social factors that impact their health care. So I always think about kind of how I get to implement practice guidelines and regular kind of pharmaceutical care but I also get to kind of do that with that extra lens of patients who probably need extra assistance and have extra hurdles.

Speaker 1:

Yeah, yeah, that's great. Well, thank you for your service in that area and also thank you for your time today. So we appreciate you taking time out of your busy schedule, so let's go ahead and jump in. So one thing I want to make clear we do a lot of education around diabetes, and usually around this time of year, because the guidelines have just come out, and it's usually focused on the new medications right, because that's what's so hot and there's been for the last few years, new medications, new classes, new groundbreaking or, as we'd like to call them, game-changing things, and so that's typically what all of your diabetes updates are about.

Speaker 1:

But we're going to be different in this episode because I really want us to focus on beyond the glycemic controls, so digging deeper into the guidelines and what is there beyond the medications. So, like, how can we affect our diabetes patients and their outcomes beyond just the medications and the changes there? So just want to make that clear for learners so that you didn't tune out and be like I just listened to the diabetes update last week. That's great, and this is a compliment to that, so be sure that you hang on for that. So okay, so let's talk about how. Just review for our learners and our listeners that diabetes is multifaceted, right? So just maybe talk about that just a little bit for us and remind us of those factors.

Speaker 2:

Yeah, so you're exactly right.

Speaker 2:

I think when we think about diabetes, we obviously jump to blood sugar right away, and that is definitely a very important factor in treating our patients with diabetes.

Speaker 2:

But when I'm thinking about diabetes kind of big picture, I'm really thinking about the comorbidities and the problems that diabetes can cause. So the macrovascular heart attack, strokes, complications and then the microvascular complications, so you know, damage to the kidneys, the eyes and neuropathies, so nerves, when I'm thinking about how do we prevent those, how do we control for those it's more than just blood sugars, it's really comprehensive care. So it's looking at a patient and assessing their blood pressure, their cholesterol, seeing if they're a candidate for aspirin or not, and getting all of those kind of underway. And then we're also looking at a lot of the screenings that need to happen and then complementary medicines if patients do have those complications. So it is like a whole world of things in terms of what we can do when we're working with those patients. And I think the glucose component is a very important piece, but there are several others that we can really be targeting.

Speaker 1:

Yeah, so maybe shed some light and maybe I'm just naive, but I feel like the non-glycemic parameters of the updates don't ever get the flashy you know awareness that everything else gets. So maybe shed some light on why that is, or also just the fact that it is a growing, important area and I do feel like it's getting more recognition in the past than it has in the past. But is there a reason for that? Like, do you have any ideas or thoughts on that?

Speaker 2:

I would definitely say I think it's getting more recognition and I think the reason is because we have medications that are finally having benefit in more than one area. So, we're thinking about kind of old school, if you will, diabetes management it's. You know, medicines that really just help with glucose control, and a lot more of our medications. The shift is to those that are not just helping glucose but helping cardiovascular risk.

Speaker 2:

So, we're seeing more of a mention of reducing those cardiac risk factors and those kidney risk factors with our new classes of medicine, so the GLPs and the SGLT2. So I think that's reminding providers that we really do need to think about those things. Another shift that I think about is the way that the ADA has organized their kind of how to do it. If you will chart a pharmacotherapy, it used to be really focused on like how much blood sugar do you need to lower? So do you add one medicine or two medicines? And it was a lot about A1C. The past several years it's completely shifted to what else is going on with your patient. Obviously they have diabetes, but what other things are happening, what's most important for this patient? And it's really kind of shifting the conversation for those next medicine steps to be based on those things.

Speaker 2:

So that's where you're seeing the kidney coming back in and heart and stroke or weight.

Speaker 1:

So it's really putting more of an emphasis on this is more than just glycemic control. We really have to focus on these other things, yeah.

Speaker 2:

Yes, because all of those things are really increasing that patient's individual risk for those cardiovascular outcomes.

Speaker 1:

Yep, okay, that's great. So I'm pretty sure everyone is probably aware that the diabetes guidelines are an annual occurrence, so they get updated and come out every year, so it is something to be sure that you are staying up to date on. So that's important first and foremost. What are some of the things that inform the changes that we see with the guidelines each year?

Speaker 2:

I'd say big picture. Just more and more data is coming out. We're seeing a really big explosion in newer medications, and then those medications we're starting to see a lot more like sub-trials, if you will looking at certain outcomes.

Speaker 2:

So obviously to get to the market they're getting the glucose-lowering data. But then we're seeing OK, well then five years later, what was this patient's cardiovascular risk in these groups? Or what was the kidney risk in this group when they're on this medicine versus placebo? So just more data about the benefits of these medications is coming out and that's really kind of changing and impacting some of the recommendations for that care for patients with diabetes.

Speaker 1:

Yeah, okay, that's good to know, and it's important again that to remember that these guidelines do come out on an annual basis, and so this is something that you need to be sure that you are revisiting on an annual basis and that you're making sure that you are implementing the most updated information.

Speaker 1:

So we don't have to be doing something with our patients that's outdated or that was so last year, you know. So, yeah, super important, okay. So with these, with thinking beyond just glycemic control, there's so many other opportunities for pharmacists, so let's touch on some of those. So what are some of our opportunities that we have in this like holistic approach?

Speaker 2:

Yeah. So that I think it's a great way to think about. It is kind of the comprehensive medication management is one of the ways that the ADA kind of thinks about it. So comprehensive medical evaluation, it's a lot of things. I'll give you some highlights now. But I'll also just kind of point out that the ADA does have like a checklist. Again, it's pretty long and pretty comprehensive, but it could be like a good spot to jump back to, and again it's in like a list form so you don't have to read every single page of the 250 page guideline.

Speaker 2:

I love a good cliff note yeah, but some big picture things is that you know every patient, once they get diagnosed with diabetes, we're automatically need to check their blood pressure and now they have a blood pressure goal and certain recommendations for pharmacotherapy for the blood pressure management. Every patient now needs to be worked up for if they're a candidate for a statin or not.

Speaker 2:

And once patients hit the age of 40, they pretty much, with diabetes, are all going to be a candidate for a statin. Those are some of the big things. And then I kind of just think about other broad things that all these patients should be kind of educated about. Everyone's now a candidate for maybe extra motivation for smoking cessation. Obviously any smoker can be encouraged to quit, but that risk factor plus diabetes is increasing the risk a lot.

Speaker 2:

And then there's some immunization recommendations that are targeted at just diabetes targeted at just diabetes, and so that can be another way that maybe pharmacists who don't feel as comfortable talking about some of these other things could also implement some of these strategies for diabetes care into their practice.

Speaker 1:

Yeah, super easy to you know, review your state registry for immunizations and see what patients are missing and then recommend those based on you know the guidelines. So, yeah, that's, that's a, that's a great point, that's a great kind of if you wanted to dip your toe in the water but you don't feel comfortable talking about the macrovascular and the kidney protection or whatever, then you know, maybe it's something you're doing, You're probably doing, I would imagine, a lot of immunization services already.

Speaker 2:

Yeah.

Speaker 1:

So that would be a really easy one to kind of tackle. Yeah, and that Even I kind of forgot about that. Even when we were prepping for this, we talked about all the different things that you need to be sure you're doing for diabetic patients, and I didn't want to mention immunizations. I feel like that is one that is just often forgot. There are specific call outs for our diabetic patients.

Speaker 2:

Yeah, so yeah, there's hep B. Rsv and pneumonia are going to be the ones that are like extra for patients that have diabetes.

Speaker 1:

Yeah, so super important. And then we all know pneumonia oh bless it, it always has such a large discussion around it, but that again is another one that is super important and we actually had a previous podcast on the increased incidence of pneumonia. We really talked about it in pediatric patients but, we often know that, you know that will. If we're seeing that in general, it's going to jump to the adult population as well. So again another reason to really kind of focus on those immunizations.

Speaker 1:

I feel like we're still reeling from the pandemic and we haven't got people back to being vaccinated yet from things.

Speaker 2:

So yeah, and the pneumonia vaccines in particular have changed, I think, every year for the past few years. So definitely one to kind of pay attention to. And there's a great app that it's like the Pneumovax app, and I even use that to remember like which one have they had, which one have they not had, and just kind of double checking myself for what patients do for yeah, Super important to make sure that patients are up to date on their immunizations.

Speaker 1:

That's a great call out. So what are some of the potential? What potential do we have for improved outcomes? So what are some of the things that we as pharmacists can really impact? I guess would be my question.

Speaker 2:

Yeah, yeah, I'd say there's, you know, obviously so many things. I do kind of think that this is one of those areas where there's just so many things on the to-do list for a patient that has diabetes that it can feel overwhelming. So I often kind of think about, like, what is your area of practice? What makes sense kind of for your practice site Like, is it the immunizations? Is it checking blood pressures and helping patients with diabetes medicine, like you know, getting on a blood pressure medicine, or at least checking their numbers and knowing what's going on and just kind of trying to figure out what would work best for you? But in terms of like, are there areas and what areas there? There's just a lot in terms of starting medications, checking blood pressures, educating about cholesterol. There's also a lot of lifestyle recommendations in the guidelines. So things about, like, how to eat well, sleep, exercise and those are all you know, things that can be worked into a conversation with a patient as you're dispensing or, if you have time, to do MTM kind of more detailed conversation too.

Speaker 1:

Absolutely yeah, and I mean, you know you saying those things. I'm thinking of adherence and making sure that we're pushing adherence. And that could be, you know, compliance packaging. That could be delivery of medications, because sometimes patients have transportation insecurities and they can't get the beds. That could be employing a technician as a CHW, a community health worker, because they can help us have better access to the medication, because that's often the cost or whatever is the reason why they're not adherent.

Speaker 2:

Absolutely.

Speaker 1:

Yeah, so you know, I just I hear those things and I think of all the things that we're probably already doing in the pharmacy's practice space and don't realize that that's exactly what we're talking about here. Like those are the things that impact our patients with diabetes heavily. So one of the other things you mentioned was nutrition. So obviously some of our you know, I know some pharmacies that offer diabetic education services and something like that but if that's not what your pharmacy does, if that's not what you do, there are ways to collaborate, right, like there are ways that we can reach out. So who would be some of the ones that we'd want to be sure we're collaborating with or that we're recommending for our patients?

Speaker 2:

Yeah, nutrition especially is one that is just so comprehensive and so impactful on diabetes management, like in such a direct way. I definitely think that there's area for pharmacists to be involved in, but there's a lot of patients who would really benefit from just, you know, 30 to 60 minutes with a registered dietitian. So I think that's a great kind of reminder that if you have those connections or if your health care center has referrals, whatever it may be, but getting those patients connected is really helpful. Another one that comes to mind is just exercise or sometimes I use the word movement with patients just to kind of stepwise get to that spot.

Speaker 1:

I was going to say. Exercise is often a dirty word, right Like oh. I'm definitely not doing that.

Speaker 2:

Yeah, so I'll say what kind of movement are you getting?

Speaker 1:

Yeah, I like that. I'm stealing that one.

Speaker 2:

But yeah, if a patient maybe would benefit maybe from some physical therapy services first. I definitely have that come up a lot with my patients, especially maybe some that are a little bit older and had an injury that never really got resolved, so encouraging that, you know, working with somebody might get them to like a space where they can do some exercises or some movement and then maybe just figuring out which ones work best for them. So maybe they're not going to ever be a runner but maybe they can get in a pool and walk around and kind of do some less weight bearing exercise but that way yeah, yeah, no, that's great.

Speaker 1:

That makes sense. So any other potential collaboration opportunities that you can think of? Because that's something that we like to make sure that we are clear to our listeners and learners, like we want you, you need to be collaborating with other healthcare providers. Everybody needs to be on the same page for the patient. So you talked about physical therapy and nutritionist, um, any anybody else that you can think of in that space. Obviously, our prescribers, but yeah obviously your prescriber collaborator.

Speaker 2:

Um, I think it's the only other one I can think of. Big picture might be eye care. So when we're thinking about those microvascular complications, eye care is going to be a major one.

Speaker 2:

that patients should be getting annual eye exams and then potentially more often if they have complications from diabetes. And then sometimes our patients are going to need podiatry care for if they have any type of nerve damage in their feet. So they're going to kind of be ruled out as candidates for doing a lot of self-care if they don't have feeling or sensation in their feet. And so getting a podiatrist's office to kind of do that routine self-care for them and then follow them and follow their care is going to be another way that we could collaborate with others.

Speaker 1:

Yeah, no, that's great. And then, obviously, if your patient is more complex and has a lot of different complications, it potentially could be that there's a renal specialist involved and things like that too. So, yeah, so I think that's another key point for us as pharmacists is making sure that collaborations are occurring.

Speaker 1:

I think that that's just one thing to look out for, because our diabetic patients are so complex that we just want to make sure that everybody's on the same page. I know my mom has diabetes and she has a lot of different prescribers and providers and sometimes she'll ask me a question about a medication and I'm like does your such and such know that you're on that? Is everybody on the same page? Because it doesn't seem like that makes sense. So you know, I think it's really important. That's another key place for a pharmacist to insert themselves and to be sure that the continuity is there, especially as a medication therapy, absolutely.

Speaker 1:

Yeah, Okay. So then what are some of the challenges? So obviously I know the first thing you're probably going to say, and the first thing anybody I ask would say, is time. So let's talk about some of the challenges. But I like to go a step further. Let's provide some strategies to implement that can overcome some of the challenges. So let's touch on the challenges first and then we can kind of brainstorm how our learners can kind of overcome them.

Speaker 2:

Yeah, I think it definitely probably depends on your practice side and how involved one wants to get in this area. For me, I think one of the things is just balancing how many recommendations there are for patients. I just want to make sure that they're getting all of these things done. So for me I make a checklist of kind of these recommendations. Again, there's kind of a list in the guidelines. I kind of have an ABCs mnemonic that I use. But I find that standardizing my practice makes it a little bit easier for me to make sure that I'm talking to patients about these things. And, to be perfectly honest, obviously, if you're going to hit all of these, you'd be sitting with the patient for two hours.

Speaker 2:

So, maybe it's the first visit talking about blood sugars and the second visit saying, hey, we haven't had a conversation about your blood pressure yet and I can kind of check on my list and kind of move stepwise through these different things. If you're somebody who'd like to tackle multiple pieces, I think getting some handouts together is really important. There's so much education. I think we all know that any one person can only remember so many things that they're told verbally in a day. So figuring out like maybe what area you're passionate about or what area makes sense to implement into your practice, and grabbing whatever resources you can and kind of focusing on that or maybe you know it's heart month this month, so we're going to be talking about all of our patients about cholesterol and next month we're going to have a flyer for blood pressure and diabetes I'm kind of thinking about a way to kind of organize that that kind of fits into your practice.

Speaker 1:

I love that. I love the kind of almost having themed months, because again, in pharmacy we see the patients most often than even other providers, and usually monthly, because they're getting monthly medications or at least quarterly if they're getting 90 days. So yeah, that's a great way to kind of think about. You know, maybe it's maybe this quarter we're focused on talking with everybody about blood pressure, this quarter we're focused on talking with everybody about weight loss and yeah, I love that idea. That's really great. So any other challenges? Obviously time, as we mentioned staffing. You know it's it's difficult to find the time to educate and to talk if, if we're you, we're inundated with verification or whatnot. So is there anything else that you can think of? That is a targeted challenge that we could maybe kind of talk about.

Speaker 2:

I can't think of anything from a pharmacist job perspective, like in terms of patients. I just reiterate kind of how impactful the pharmacist can be. So I think you might've mentioned this. But, like, adherence is obviously so important and I think not just the medicines that we know lower glucose, but this whole kind of array of medications, that kind of add to helping with their diabetes control and the comprehensive management.

Speaker 2:

So a pharmacist, especially a dispensing pharmacist, is going to be one of the first people who identify as non-adherence whether that's forgetfulness, whether it's just not understanding the purpose of a medicine or really what I commonly see as side effects and patients just not really fully understanding a side effect or worried about a side effect and a really easy spot for pharmacists to say like hey, what's going on? Is there something I can help you with? Maybe it's as simple as changing the timing of a medicine from bedtime to morning. Or maybe it's as simple as you know, switching between classes or having a patient encouraging them to talk to their prescriber sooner. But that's like an area that you know, not any other. I think area of healthcare has such quick and easy access to solving that problem of healthcare has such quick and easy access to solving that problem.

Speaker 1:

Yeah, yeah, you brought up a great point and, in true fashion, I lost my train of thought and I was going to say something so impactful and now I don't remember what it was, so hopefully it'll come back. Everybody knows that I talk a lot, so we'll just keep talking and it'll come back to me. But, yeah, so one of the things, too, that you mentioned is that we are stressing the importance of us making sure the patients realize how impactful we are to them, because I think that that is that is key as well, and, and that you know, a lot of that takes you owning the knowledge that you have as a pharmacist, because it's there, and feeling empowered to talk about those things with the patients, because it's it's things that need to be discussed. Yeah, that's great. So let me I'm still trying to pull out my thought. It was such a good one, justine. Oh well, okay, maybe it'll come to me in a minute, we'll see.

Speaker 1:

Okay, so we talked. We talked a little bit about some quick steps that our pharmacists and our learners can kind of can kind of go back and do and implement, because timing is an issue and staffing is an issue. Anything else in that realm you kind of mentioned, like tackling one thing at a time, or the list, or the monthly or whatever anything else you can think of, to kind of give them a tip or trick to to choose, like, I guess I don't want to quantify this, but is there one complication that we should focus on more than others, like, is there one that we see as being? Like weight is the one that really plays a factor?

Speaker 2:

so let's get their nutrition under control, like would you think, yeah, I'd say they all are, just they interplay so much with each other. But perhaps kind of thinking about it the other way is, I think, being knowledgeable and I know you already probably have covered this in other topics, but about some of these new classes that do impact multiple areas, so the ones that are helping glucose but helping weight and helping cardiovascular risk, if I was going to like choose how to spend my time to really get the most knowledge and be the most kind of ready to talk to patients, I would kind of think about focusing on those two for one and three for one classes of medications that are helping glucose but then also helping, like I said, the weight and cardiovascular risk or kidney disease.

Speaker 1:

Yeah, that's great. Oh, I just remembered. Yay, I did. I remembered I was going to touch on the fact that I know that obviously this episode is more geared toward the non-glycemic control, but we haven't even mentioned CGMs and their and making sure that patients are, and I know that they are obviously tracking glucose, but they do so much more and they have some such a bigger place, I think, right now in practice than they've ever had. Even beyond glycemic control patients patients who don't even have diabetes are wearing them now to help, you know, kind of monitor their nutrition and their weight loss journey and things like that.

Speaker 2:

So anything you want to share in that space, in the CGM space that you've found to be useful or helpful? Yeah, I'm definitely. I mean, obviously we're seeing an explosion in the availability of products and, I think, the coverage of products and then now with over-the-counter products, you patients are able to have access you without prescriptions. We're also seeing a trend in supportive data to use CGMs in more and more populations and we're there's an expansion in the ADA guidelines this year to saying we should be looking at these and patients with type 2 diabetes, even those that aren't only on insulin therapy. So I think that that's great because it's encouraging more payers to pay for them. But yeah, you're right, there is such a wealth of information in those devices, one for patients and two as a provider. If you haven't had that opportunity before, it's very, very easy to get access to a patient's data and set that up if they're willing to share the data with you, and you can just see so much and have just really wonderful conversations with patients about blood sugar control medications.

Speaker 2:

And then, honestly, I spent a lot of time talking about lifestyle, so foods that they ate and their CGM. So you know, looking at the numbers with them, like wow, it looks like last night you had a really big dinner, your body had a very hard time with it and your sugars were up for a very long time. Do you remember what you ate? And then there's some data to kind of talk about, just asking patients either avoid that meal or to have less of that kind of a meal and just kind of simply kind of looking through that with patients. So I think some people have a good understanding of what's healthy or not healthy. Some patients have a good understanding of what foods have a high glycemic index or not. But when you have that CGM and you just see your number go up and stay up for a very long time, it is just really great kind of instant feedback for a patient that that was a hard meal and you need to probably switch things up for another meal and avoid that.

Speaker 1:

Yeah, probably switch things up for another meal and avoid that. Yeah, and it's a great point to call out that we can utilize the data on a CGM in such a powerful way. So, yeah, and we have lots of other education, like you mentioned, on CGMs. We have advanced training on CGMs for implementing a CGM service in your pharmacy. So lots of information out there on it, because it is such a hot topic right now.

Speaker 1:

But I felt like I'd be remiss if we didn't at least mention it in this space, because I do feel like it goes beyond, you know, the glycemic control portion of it. So, yeah, well, wow, this has been so good. Justine, is there anything else that you feel like we need to highlight? I think we've talked about the importance of managing these other issues that are related to our patients with diabetes beyond glucose. We've talked about some of those quick tips and tricks that our pharmacists can do and kind of dip their toe in the water. Maybe it's immunizations, maybe it's blood pressure checks, maybe it's, you know, referring to a nutritionist or bringing in a dietician once a week for a class or something Anything else that you can think of to leave with our learners.

Speaker 2:

I think that you really mentioned a lot of the big things. There's just a lot of opportunities, and figuring out which one makes the most sense for you to bring into your site at any given time is probably the best recommendation I have, and then using the guidelines, I think, to work for you.

Speaker 2:

I think the ADA does a great job of having some nice charts with prices or some nice charts with considerations for medicines and so I know, I personally print that chart that's the drug chart and I think chapter nine every year and just update it and plop it on my wall. So you know, work smarter, not harder, and grab those things and have them there for your reference.

Speaker 1:

They. They spend a year putting those out for a reason. So it's for us to utilize and access them, yeah for sure. And then you know I think you mentioned too you know, I feel like pharmacists in general are known as the medication experts, and so it's important that we are up to date on things and that we're able to share that education with patients. So I think education is another way.

Speaker 1:

So, if you take anything from this, I want to challenge listeners to take one small thing and do it. Whether it's focused more on immunizations, or maybe it's focused more on your patients who are also on blood pressure meds, or maybe it's focused more on your patients who are also on blood pressure meds, or maybe it's focused on making sure they're started on a statin if they're eligible, you know whatever. So I think that's my challenge for our listeners today. So, and then back to you, justine, with a summary of what's our game changer here. I always like to ask the guest for our game changer podcast to kind of summarize today's lesson what's the game changer take home for our learners?

Speaker 2:

Yeah. So I'd say the game changer here is just remembering that beyond glucose control we have many other parameters for comprehensive diabetes management. So that includes blood pressure, cholesterol, aspirin, working them up for microvascular complications so their eyes, kidneys, neuropathy and then immunization. So all of those things kind of go into comprehensive management for diabetes. So there's many roles for a pharmacist to get involved in, even beyond just helping pick or educate on glucose lowering medicines.

Speaker 1:

Yeah, that's great. Well, Justine, this has been wonderful. Thank you so much for your time and for joining us today. We really appreciate it.

Speaker 2:

Thank you.

Speaker 1:

If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week.