October 6, 2011

More questions for AADE

This continues the discussion of AADE and how they are going to continue to improve when they leave so many issues unanswered and seem to ignore many of them as if they were hot potatoes. Maybe the AADE needs to encourage their CDEs to get back to some basics and treat people with more respect, more empathy, and do more education.

Continuing with questions for the AADE - how are they going to work with e-patients, empowered patients, and proactive patients, then add patient advocates? One group of people most CDEs seem to avoid are patients that is proactive and empowered patients. Patients that have education about diabetes seem to bring out the worst in CDEs. Twice I have had CDEs bristle and say that they were in charge and that I was to listen and keep my mouth shut. That alone ended the appointments and any further contact.

I have not seen or heard anything about e-patients, but in talking with a patient advocate recently, he described the behavior of a CDE. He told me, she said that she did not have to deal with an intermediary and for him not to be present at the next appointment, and left the appointment.

In the blog written by Donna Tomky, the new President of the AADE on DMine, she gave the following - - DSMT = Diabetes Self-Management Training (official term for working with a CDE). This is a sore point with me and diabetes self-management training is not something most CDEs seem willing to do. From my experiences, they are more comfortable with issuing mandates, telling people what they need to do, than in doing any training.

When it comes to training, many patients are not satisfied with the limited “training”, if you can even call it that, people are receiving. More patients are interested in self-management blood glucose training (SMBG) which is applicable for day in, day out living. I know that the informal group I associate with will not meet with a CDE that promotes A1c's of 6.5 to 7.0 percent. Except for me, the group maintains A1c's of less than 6.0 percent. I am near this, but have only been able to achieve this twice.

Now that AADE has their Guidelines for the Practice of Diabetes Education, what are they doing with them? How will CDEs that sidestep and avoid these guidelines be handled? Will they be told to do better and that is all. I have a suspicion that is what will happen. I say that CDEs that ignore and tromp on the guidelines should be stripped of their certification. The same should go when they refuse to work with level 1 people and do everything to have them excluded and left out of patient discussions?

Another question - when will AADE realize the value of other programs like blood glucose awareness training (BGAT)? With many type 1 and type 2 people on insulin that are having problems with hypoglycemia, it seems reasonable that more CDEs would be using this to assist these people in dealing with hypoglycemia. I do not know of any type 2 presently that are hypoglycemically unaware, but this training should be ideal for anyone that is unaware they are having a low.

A last question for now – when will CDEs start talking about insulin usage early on after diagnosis for managing diabetes rather than as a treatment of last resort. A lot of people with type 2 diabetes have irreversible damage when they are put on insulin. I realize that doctors are not supposed to do any harm, but why do CDEs have to follow the doctors doing harm and use fear to encourage patients to stay on oral medications? What are you supposed to do when a CDE sees that you are insulin and makes the following crack, “you poor fellow, how much longer are they giving you?” What followed was very short and I'm afraid everyone in the office complex overheard my rant. That has been almost seven years ago and I had the neuropathy and sleep apnea before my diagnosis of diabetes.

Except for a few thousand of the certified diabetes educators that are dealing with most of the questions and issues I have mentioned, and work for places like Joslin Diabetes Center, the Behavioral Diabetes Institute, and other enlightened medical practices, something does need to be done to retrain most CDEs. Oh, and the CDEs that stand up for what is right in the face of being hounded out of practice by uncaring colleagues, they need our support. Those that are doing an exemplary job should not be punished for the errors and intransigence of the many.

No comments: