October 5, 2011

Is the AADE Actually Making Improvements?

Amy Tenderich had a guest blogger on September 29 that answered some of questions about the American Association of Diabetes Educators (AADE). Yes, this is the certified diabetes educators (CDEs) we are discussing. They have made some improvements over the last year, but there is a lot more that needs to be done. These are a few of the ideas I want to cover.

First, there needs to be better continuing education. Their formal education is good. They stay up-to-date about equipment and some studies, but many CDEs are still lacking key pieces of information. Many do stay current with the latest changes in the American Diabetes Association guidance, but others seem to be stuck in the past and therefore make recommendations and mandates that are not always in the best interest of the patients.

So my first question is – does the AADE have a procedure for filing complaints about CDEs that give outdated advice or that do not work with patients? Then what do we do about those CDEs that cannot be civil when you ask a question that they do not like?

My second question is - what are they doing to help people with depression? Many CDEs seem very lost when this topic is brought up. Their eyes glaze over; they attempt to change the subject or do their best to divert the conversation away from the topic.

My third question is - are they going to allow people to use lower carb diets? Many, but not all are stuck on having people eat 60 carbs per meal and telling us that we are harming ourselves if we eat less that their mandated amount. Even the ADA has moved away from the mandate of 60 carbs per meal. For most of the CDEs I have met, this seems to be a mantra.

At this point it is important to note that ADA has (hard to believe, but true) changed their position about carbohydrates. Check out Standards of Care section of the 2010 ADA Clinical Practice Recommendations. The updated carbohydrate recommendation starts on page S25 and I quote it - “Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, it is unlikely that one such combination of macronutrients exists. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For those individuals seeking guidance as to macronutrient distribution in healthy adults, DRIs may be helpful (106). It must be clearly recognized that regardless of the macronutrient mix, the total caloric intake must be appropriate to the weight management goal. Further, individualization of the macronutrient composition will depend on the metabolic status of the patient (e.g., lipid profile and renal function) and/or food preferences. Plantbased diets (vegan or vegetarian) that are well planned and nutritionally adequate have also been shown to improve metabolic control (107,108). The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intake so as to reduce risk for CVD. Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes; therefore, the recommended goals are consistent with those for individuals with CVD (92,109).” (Emphasis is mine)

This will now allow variation of carbohydrate consumption to fit the individual and not forcing a certain number of carbohydrates. The low fat regimen is still advocated, but even this can change. In a discussion with a CDE, I was told in no uncertain terms that this was not accurate and I was to eat the 60 carbs per meal. This inflexible position is not acceptable and my discussion with this CDE ended.

There are many more questions that I have, but I need to get my thoughts organized and collect more information. The AADE still has more to correct and improve upon.

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