June 23, 2015

The Diabetes Education Follies – Part 2

A phrase that Brian Cohen enlightened me with during the last week is "treat to failure" protocol of medications and many other aspects of diabetes. Thank you, Brian! Now I won't blame every doctor, as there are some that will prescribe insulin early and will actually work with patients to improve their health. It is unfortunate that most doctors do treat to failure and then belittle their patients and accuse them of failing when it is the doctors that have failed us.

Now granted, we could have been more informed and insisted that the doctors prescribe insulin, but even with this, most will not and will continue to blame us for their failure as doctors. Yes, I am on a rant and for good reason. This goes back to the recent ADA Scientific Session in Boston, which I did not attend. The joint statement issued by the American Diabetes Association (ADA), The American Association of Diabetes Educators (AADE), and The Academy of Nutrition and Dietetics (AND) is touted as the end-all, one-size-fits-all solution for our diabetes education woes. Not likely, is my response.

With approximately 30 million type 2 diabetes patients and at most about 18,000 CDEs, I will use the number of CDEs from the AADE 2015 Fact Sheet which states there is more than 14,000 CDEs. This means that for this many patients each CDE could spend one hour with all but 103 patients using 14,000. Let me explain why this will not happen. There are many retired CDEs, many are only working part-time, others are writing books and on book signing tours, and this does not even count those not working as CDEs. Many CDEs will only work with type 1 patients and this leaves those with prediabetes unserved.

From the AADE fact sheet (a PDF file) 61 percent are nurses, 11 percent are pharmacists, 25 percent are dietitians, and 3 percent are other health professionals. This means that most are required to work in their primary profession to earn a living. As such, CDEs seldom work with any diabetes patients other than those with type 1 diabetes. I have learned more on my own and from a nurse practitioner than from a CDE. Even my non-CDE pharmacist has given me good diabetes information. I have a second cousin that is a CDE, but we don't talk anymore because of my bias.

In the area of Iowa where I live, there are a few CDEs, but mostly they are working for hospitals and a couple of diabetes clinics. There are a few others, but not in the immediate area. My wife surprisingly received a good deal of her education from a nurse/registered dietitian. This did take me by surprise and the education was much better than I had expected her to receive. Carbohydrates were not pushed, but actually discouraged. Most fat was also discouraged, but not totally.

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