June 24, 2015
The Diabetes Education Follies – Part 3
When it comes to certified diabetes educators (CDEs), there has been much controversy over the last several years. A few of the things I have noticed may have changed a little, but there are continuing problems. First, there needs to be better continuing education. Most CDEs have good formal education. They stay up-to-date about most of the equipment and some studies, but many CDEs are still lacking key pieces of information. Many do stay current with the latest changes in the American Diabetes Association guidance, but others seem to be stuck in the past and therefore make recommendations and mandates that are not always in the best interest of the patients.
One question I have asked that still begs an answer is - does the AADE have a procedure for filing complaints about CDEs that give outdated advice or that do not work with patients? Then what do we do about those CDEs that cannot be civil when you ask a question that they do not like?
My next unanswered question is - what are they doing to help people with depression? Many CDEs seem very lost when this topic is brought up. Their eyes glaze over; they attempt to change the subject or do their best to divert the conversation away from the topic. Some even leave the appointment.
My last question is - are they going to allow people to use lower carb diets? Many, but not all are stuck on having people eat 60 carbs per meal and telling us that we are harming ourselves if we eat less that their mandated amount. Even the ADA has moved away from the mandate of 60 carbs per meal. For most of the CDEs I have met, this seems to be a mantra.
I am very upset about another problem that has been happening since the formation of a new CDE organization. It is serious enough at present, but with the activities of one certified diabetes educator group and their activities in opposing anyone being able to assist in education, it will become worse. This group is declaring that only CDEs are capable of giving this education and others are not capable is the height of being conceited. With both CDE organizations unwilling to use telemedicine or group education, education will become a short commodity, especially with the recent joint statement.
I will give credit where credit is due and that is many doctors in rural areas are taking diabetes patients that are willing and giving them education about diabetes to work for them as peer mentors or peer-to-peer workers. I have even been pleasantly surprised by the response I have received from the two doctors in Kansas that I have volunteered for as a peer mentor in the past. They are having many of their patients ask me questions via email because they are not getting many questions answered by the telemedicine operation in Kansas. Time seems to be a constraint.
No help is being provided by our government to encourage diet change. The USDA keeps promoting whole grains and other high carbohydrate foods instead of low carbohydrate, medium to high fat nutrition. We also have the corn and wheat organizations influencing the registered dietitians to promote this as well.
This has really put a burr in my saddle. Doctors, in their jaded wisdom, have coined the term "diabesity" to reflect the combined effects of the diabetes and obesity epidemics. They claim that the two go hand-in-hand, but give no reason for those obese patients without diabetes. And why should those people that are thin and diagnosed with type 2 diabetes need to put up with these prejudiced doctors. Plus these same doctors are not doing anything to educate patients or applying pressure to our government to change the nutrition of the population.
Lastly, I want to question the futurefor the CDEs. Is there a future for the American Association of Diabetes Educators (AADE)? Not if the Academy of Certified Diabetes Educators (ACDE) has anything to say about it. At present, they both have members that have taken the test given by the National Certification Board for Diabetes Educators (NCBDE) and passed it. The ACDE is taking the exclusive route and not allowing honorary membership and is lobbying hard in a few states to prohibit anyone with knowledge of diabetes from passing this on to other people with diabetes. This includes peer-to-peer diabetes workers, peer diabetes mentors, diabetes coaches, and others. Fortunately, one state had defeated their bill. A second state put the bill on hold and it will be reintroduced next year.