Can anyone say 'pipe dream'?
That was my first thought when I read this. No, I am not kidding. Yes, there are some advantages for some
people with diabetes that live in some of the larger metropolitan areas. Those people living in rural areas will still
not have an advantage and may not even be able to utilize the increased
educational opportunities.
What is a surprise is that the joint statement by the
American Diabetes Association (ADA), The American Association of Diabetes
Educators (AADE), and The Academy of Nutrition and Dietetics (AND) focuses
primarily on type 2 diabetes while the general principles apply to everyone
with diabetes. The joint statement is primed
to fill the gap not covered by other guidelines addressing medication use and
HbA1c targets.
The joint
statement calls for referrals to accredited diabetes education programs at four
key points: at diagnosis of diabetes, on an annual basis, when new complicating
factors (diabetes-related, or not) influence self-management, and at the time
of transitions in care, such as from pediatric to adult or for an adult to
nursing home. The document provides
detailed guidance for issues that should be addressed at each of those points.
It is
noteworthy that the Academy of Certified Diabetes Educators is excluded from the joint statement. Whether they will shirttail on the joint
statement remains to be seen. Either
way, this still leaves the total number of CDEs way short of what will be
needed to meet the goals of the joint statement, especially the people with
type 2 diabetes.
Other
factors affecting the joint statement include:
1.
Many CDEs do not live in largely rural areas.2. Many doctors have had unfavorable encounters with CDEs and won't use them.
3. Many CDEs will not work with some doctors and contradict much of what the doctor has ordered creating additional problems.
4. Most CDEs do not want to work with people with type 2 diabetes that are managing their diabetes well.
5. Many CDEs are also registered dietitians (RDs) and often will not work with the new nutrition guidelines, especially the low-carb/high-fat food plans.
6. Many RDs do not accept the exclusion of whole grains, again leaving many people with diabetes out of the education. This is because the RDs often will not do any education for those of us excluding wheat.
7. Many doctors also promote low fat and whole grains because they still in believe Keyes and will not accept that he has been disproven.
The
following is contrary to what the Society of General Internal Medicine (SGIM)
promotes. The SGIM does not believe in
education for people with diabetes and follows statements made by prior
influential people in the ADA and American Association of
Clinical Endocrinologists advocating that people with type 2 diabetes, not on
insulin rely on their HbA1c results to manage their diabetes.
Surprisingly,
Martha M Funnell, RN, research scientist and adjunct nursing lecturer at the
University of Michigan, Ann Arbor stated, "There
is actually a substantial body of research on the value of education, including
lowering hemoglobin A1c levels, reducing the onset or advancement of diabetes
complications, improving lifestyle behaviors, reducing diabetes-related
distress, and improving quality of life."
Ms Funnell
continued, "The literature also
shows that diabetes education is cost-effective, particularly in reducing
hospital admissions and readmissions. Studies
have also shown that patients who receive diabetes education are more likely to
receive kidney and eye screenings."
Medication
costs typically go up with diabetes education, "but that's because people are actually taking their medications
and getting their prescriptions refilled. So, diabetes education works," Ms
Funnell noted.
But despite
the benefits, one recent study showed that among adults aged 18 to 64 years
with diabetes, less than 7% had received formal diabetes education. "While
less than 7% is a great A1c number, it's a really lousy number for the number
of people who get education," Ms Funnell quipped.
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