January 21, 2016

Reasons for Ignoring Diabetes Education

Riva Greenberg starts a great blog, but then ends it by asking questions of the past AADE President Deborah Greenwood, PhD, RN, BC-ADM, CDE and the 2016 President Hope Warshaw, MMSc, RD, CDE, BC-ADM. Notice the multiple titles and especially the current president of RD, CDE. The past president is an RN, CDE.

This means that the RD will be emphasized to CDEs and other dual titles. Our support group has been wondering if we would have more luck in 2016 to receive diabetes education, but with this president, we do not think this will happen.

Most of our members are tired of going to an appointment for diabetes education and not receiving education, but nutritional advice of low fat, high carbohydrate advice, which the insurance won't pay for when they only approved for diabetes education. Most of us get the standard mandate of whole grains and 45 to 70 grams of carbohydrates per meal. Yet, the RD/CDEs insist that they should be teaching nutrition. Or, they give out mandates of getting more medication to cover the carbohydrates consumed and they tell the doctors to up the dose of medication or add another medication. So typical of CDEs that do not understand the value of low carb, high fat, moderate protein food plans. This means we don't need a higher dose of medication (insulin or oral) and do not need to add another medication.

We have had discussions with our insurance company and they are happy with the cost savings that have happened of the last few years and have now accepted Suzanne and Allison as nutritional advisers for most of us and they see the nutritional benefits in the different test results and cost savings. The insurance company has also allowed splitting the two hours they require, as they know we obtain more benefits by using this method.

After several complaints about CDE/RDs only teaching nutrition, the insurance company sends a letter that they will only pay for diabetes education and not to submit if they did not teach diabetes education. All CDEs have canceled when this happens. Most know that we have our own nutritionists and that the insurance is paying them and they don't like this and want to use up the time when possible.

In addition, we are now asking the CDEs to teach Self-Monitoring of Blood Glucose (SMBG). Since they do not want to teach the importance of testing, they have told the doctors that the ADA advises that well controlled diabetes do not need to test, but rely only on the A1c. This is thanks to Dr. Robert Ratner, chief scientific and medical officer for the ADA.

This is one reason we think that CDEs need to be ignored and not allowed to give bad education in the form of mandates, mantras, and dogma.

Now I suggest you read a blog by David Mendosa that has a different approach about CDEs and DSME. It is different and more positive than mine is. My blog reflects what our support group members have experienced.

Important NOTE:  According the Dr. Bill Quick's website, the Academy of Certified Diabetes Educators is now defunct.  Dr. Quick says this is one less cook in the kitchen.  I can't say I'm sorry that this has happened.  Too many things were not being covered and this leaves the AADE back in charge of CDEs, which basically means doing nothing for people with type 2 diabetes and prediabetes. 

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