June 25, 2015

The Diabetes Education Follies – Part 4

Dr. Robert Ratner, chief scientific and medical officer for the ADA says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," in talking about oral medications. Dr. Ratner must be muttering to himself now 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.

Dr. Ratner is the person many doctors quote when they won't recommend testing supplies and has enjoyed a position of high esteem among these physicians. Unfortunately, he will maintain this position because very few CDEs will be doing education for people with type 2 diabetes. The few that may receive education will be among the 20 to 25 percent of type 2 people using insulin in the larger metropolitan areas.

In the conversation with my cousin Beverly, she asked why CDEs do not teach DSME to type 2 people on oral medication. I explained about Dr. Ratner and his statement and that CDEs will generally not teach even self-monitoring of blood glucose (SMBG) which is part of diabetes self-management education. Her husband Tom asked how the support group knew so much about it. I said because we have done our research and learned this by working with each other. I took time to show him Alan Shanley's blogs on the same topic and he bookmarked his blog for reading later.

Beverly said there is a lot of need for CDEs is this area, and I agreed. I said with three community colleges and four colleges in about an hour's drive, there is a great need even among type 1 people. I said that there are several type 2 diabetes support groups, but I am not aware of any type 1 diabetes support groups. Tom admitted that he felt most comfortable with our group even with most being older them him. He said it is probably because you accept people as they are and are not afraid to take on any topic. I thanked him and said we have had some growing pains and the last three weeks have been nail-biting, but we survived and now the summer is here and we will not have any meetings until September.

I told Tom that depending on his schedule, we could get together a few times and discuss different issues, or we could do most of it via email. Beverly then dropped a bomb on both of us. She said that the hospital had asked her to earn her CDE certificate because the two nurses that had certificates were retiring later this fall and they would be without a CDE. She said one of them really hadn't done much CDE work for the last two years. She concluded that the hospital would pay for her additional education and testing.

I told Beverly that as long as she could put up with my bias and not be upset with the comments I might make, that she should go for it if she had interest in doing it. Beverly said she had talked with the other CDE cousin that was not talking to me and felt that it could be interesting. We talked about the second CDE organization and I had her read a few of my blogs about it. She said that the seemingly exclusive attitude was a problem for her as she would be teaching a lot to Tom and she liked the peer mentor or peer-to-peer worker ideas I had promoted. At that point, Tom suggested that they needed to leave and they did.

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