Part 1 of 6 Parts
When I first started reading this, my
thought was to bypass it and maybe consider this later, if at all.
Something made me come back and read some parts, and ouch! I must
say my wife was surprised and asked me what was making me roar with
laughter. In reality, this is not funny, but the content and some of
the ways they approach different parts do make me wonder.
It starts with the first paragraph. I
see these numbers in most sources and can believe that they are
realistic as estimates. The algorithms used probably make these
numbers more accurate than we realize. Now is where the amusement
starts. The American Association of Diabetes
Educators website formerly had listed memberships of about 13,000
members. They have now removed this number for whatever reason and a
search of the site does not reveal the membership numbers.
With 18,800,000
people with diabetes and 13,000 CDEs (certified diabetes educators),
this means that allotting one hour per patient would mean seeing
1,446 different patients per year and having 594 patients they could
see twice a year. This is figured on a 2,040 hour work year and
allowing 80 hours for vacation or two weeks. Now we know these
numbers are not realistic as many patients are seen four times per
year, or more. We don't know how many CDEs only work part-time, how
many are not doing actual educator work, how many are retired, how
many are in administration, and other numbers writing books and going
on speaking tours. We know that most people with type 2 diabetes
never even see a CDE, therefore we have to question if the CDE
membership numbers are realistic. This says nothing about many
rural areas of the USA where no CDEs live.
I did not include the seven million
people that are estimated with undiagnosed diabetes because the CDEs
would not be seeing them. Nor will I include any of the estimated 79
million people said to have elevated risk of type 2 diabetes. Then
for the people on the “Task Force” for developing the standards
to make this statement, “Diabetes
self-management education (DSME) is a critical element of care for
all people
with diabetes and those at
risk for developing the
disease,” (bold is my emphasis) really makes me laugh as
many CDEs do not even teach DSME. They seem to prefer mandates and
mantras to doing an actual assessment and developing an education
plan based on any assessment.
Until the AADE starts a division for
peer-to-peer workers and peer mentors and gives them some of the
skills needed, there will not be sufficient people to use DSME or
give DSMS (diabetes self-management support) to the people with type
2 diabetes, much less those at risk for developing the disease. The
standards have high ideals, but not the personnel to make them work.
This is why I needed to laugh to avoid becoming angry.
When I read statements like this blog,
and I have to agree with the sentiments expressed, and then along
comes a comment like the first comment, it really points out the
problems existing in our healthcare system. It also points out the
problems in the CDE profession and their attitude about people with
type 2 diabetes. I am not denying that people with type 1 diabetes
may need more education and support than many people with type 2
diabetes. For people to say that endocrinologists should be
exclusively for people with type 1 diabetes is not realistic. More
people with type 2 diabetes are finding out that insulin works for
them and has less side effects than many of the oral medications.
They also need the education and support.
If you are concerned about peer-to-peer
workers, peer mentors, and think I am pushing my own agenda, read
this by the Standards Task Force.
“In the
course of its work on the Standards, the Task Force identified areas
in which there is currently an insufficient amount of research. In
particular, there are three areas in which the Task Force recommends
additional research:
1. What is the influence of organizational
structure on the effectiveness of the provision of DSME and DSMS?
2. What is the impact of using a structured
curriculum in DSME?
3. What training should be required for
those community, lay, or peer workers without training in health or
diabetes who are to participate in the provision of DSME and to
provide DSMS?”
Yes, this is one of my aims and I am
happy to see the Task Force suggesting that it be researched. While
it is being researched, it needs to be acted on now as the number of
people developing diabetes will continue to grow and the numbers of
CDEs is not growing at a pace to keep up.
As for research on the influence of
organizational structure on the effectiveness of the provision of
DSME and DSMS, all we need to do is look at what has happened with
DSME in the past. The organizational structure may be there at the
upper levels, but at the practicing levels, there is no support for
it except from rare individuals. There is also little research and
support for DSME for the elderly as many CDEs will not work with them
and consider this a waste of time since these people are no longer
contributors to society. I have written about this here and here.
It will remain to be seen if they will consider the value many of
these elderly people could contribute as peer workers. Just don't
hold your breath waiting for this to happen.
I would urge everyone to take the time
to read the National Standards to be able to understand what may be
possible. I would also encourage this so that if allowed, we are
ready for an intelligent dialog and if denied this, as a way to hold
the feet of the CDEs (including the AADE) to the fire. This may be
only one of the ways we can break the exclusionary lock they
presently have and are still very much trying to hold onto by keeping
lay people out.
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