October 4, 2011

Old Problems in Diabetes Education

An examination of an article and the progress being made is in order. Amy Tenderich made some convincing arguments in her article of November 15, 2007 in Diabetes Health. Then in the reply to these problems by Donna Tomky on Amy Tenderich's blog of September 29, 2011 was a pleasant surprise, but still left many questions needing discussion, if not still needing complete answers. We can accept that an organization like the American Association of Diabetes Educators (AADE) that may be slowly coming out of the doldrums of past ineffectiveness to take some time in getting things set to the right tone and accomplishing many of its new goals.

In reading some of AADE's position papers, they are being aggressive, but the membership is slow to give support. Too many have become engrained in bad habits of the past and are not ready to support the new positions. CDEs that have turned to writing books and making speeches are not supportive of the changes. Many of these CDEs have created their ladder to success and are resisting change.

In addition, many of the problems still exist because of a healthcare system mired in more ineffectiveness and concern for profits then preventive care. Our outdated medical insurance industry is even fighting harder to further increase profits at patient expense than in looking for new ways to battle the increase in medical costs. Tests are over used in many cases and insurance just continues to pay for them and pass the costs onto patients with ever-increasing premiums.

Amy found several excellent problems in 2007 worth repeating. The first was “Create a sensible career path for new recruits, including some type of mentorship”. Has this been established? AADE would like us to think so. In Donna Tom Tomky's statement, she says: “One of the most significant ways that the discipline has been strengthened since 2007 is by the development of documents that support and clarify the roles and scope of practice for diabetes educators. In 2009, AADE released The Guidelines for the Practice of Diabetes Education and the Competencies for Diabetes Educators.”

Translation – they have made it more difficult for entry into the certified diabetes educator position and made it restrictive in who they accept. This does nothing to create a career path making it easier to attain a position as a CDE. There is still nothing in the works for college courses to aid in the study for the exam and further restricts people that are eligible to become CDEs.

The second point of change put forth by Amy is “Streamline patient access to educational services”. This was not even covered by Donna Tomky other than to restate that people need a doctor referral so that they are eligible to bill their time to insurance companies. What are patients to do when they see a doctor that will not refer them or that the doctor has no one available in the small rural community? This is not a promising answer for a solution.

The third point Amy put forth is “Garner consistent support from both physicians and insurance providers for diabetes programs”. This is partially covered along with the above point in Donna's point: “We are particularly pleased to begin work on a new demonstration project focusing on mobile health. With the Office of Minority Health, Baylor Diabetes Health and Wellness Institute and AT&T, we are facilitating a project that will connect diabetes educators with patients via mobile technology and video platforms. We believe these mobile technologies have huge potential to revolutionize the way educators can interact with their patients and increase access to diabetes education services, particularly in rural and under served areas”.

Granted this is still in the development stage and we do not know how far this will go. Will the program be for minorities only? Will the program be nationwide? These are just a few of the yet unanswered questions.

Amy's fourth point is “Establish accepted best practices for diabetes treatment that are clearly communicated throughout the field”. And, the last point in Amy's list of needed changes is “Drive more proactive participation from the patient community”.

Unless I missed something on Donna's reply, these two points were completely unanswered. In place of answering the above, we were told about “Establishing State Licensure for Diabetes Educators”. Read this for more information and if interested there are some valuable links. This could open a can of wiggly worms but may well be worth the fishing.

I will continue the discussion about more questions for the AADE and maybe a few challenges, in my next several blogs.

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