June 12, 2015

Diabetes Self-Management Education May Have Received a Boost

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.


Denise said...

I just don't see how any responsible medical professional could still, in good conscience, promote a diet high in grains. Has anyone ever been able to manage their T2 diabetes successfully (with or without meds) on that type of diet? I'm not following an ultra low carb eating plan (I shoot for between 60 and 100 grams per day), but I avoid any processed grains and am highly selective about those of the non-processed variety as well, and both my meter and my A1c show that my plan works well for me.

Bob Fenton said...

Denise, You are a great example of what 'eating to your meter' means. Each person needs to find and follow the food plan that works for them and that their meter says works. Following the exact food plan that someone directs you to eat never works.