July 27, 2016

Why Is the Best Diabetes Treatment Unavailable to Us?

Yes, diabetes education is by far the best treatment for diabetes, but why is this treatment so seldom taught to people with diabetes. This is a blog to answer a speech by Dr. Margaret Powers at ADA last month. Dr. Powers asked why access is so low. She is the current President of Health Care and Education at the American Diabetes Association and promotes diabetes self-management education, or DSME for diabetes patients.

Her speech could have been more effective if she would have declared that DSME was for people with type 1 diabetes. Then she could have correctly stated that only 7% of individuals with private insurance and 5% of those on Medicare receive this type of diabetes education. Those numbers are much lower than many would expect.

In her address, titled “If DSME Was a Pill, Would You Prescribe It?”, Dr. Powers argued that diabetes education is one of the best treatments available. She received a standing ovation from the packed ballroom, arguing that access to education must improve.

Here are three highlights from her presentation:
  1. If diabetes education were a medication, it would score highly across the official ADA/EASD diabetes management criteria: efficacy, hypoglycemia risk, weight loss, other side effects, and costs. Studies have shown diabetes education provides significant reductions in A1c and the risk of hypoglycemia, improves weight loss and other side effects, and is reimbursable by Medicare and most private insurers.
  1. Diabetes education can increase healthcare savings. Dr. Powers pointed to one notable study (Health Care Use and Costs for Participants in a Diabetes Disease Management Program, United States, 2007-2008) that found the average annual hospital charges for 33,000 patients who received any education was 39% less than the yearly average for those who received no education.
  2. Diabetes education provides psychological benefits that medications do not. Dr. Powers shared that education reduces diabetes distress and the often hidden emotional burdens that come with managing diabetes (see past diaTribe coverage on distress with insight from Dr. Bill Polonsky). Studies show diabetes education also improves quality of life, coping skills, knowledge, self-care behaviors, healthy food choices, and physical activity.”
The above is true, but much of this excludes people with type 2 diabetes. What Dr. Powers fails to talk about is lighting a fire under the members of the American Association of Diabetes Educators (AADE) and especially the insurance cartel to properly pay CDEs for their time if they actually teach education.

Many do little education and most use mandates, mantras, and dogma instead of education. Then when they also have a second title of registered dietitian, most of these dual titled CDEs switch to teaching nutrition and do no diabetes education. Our support groups knows this from first hand experience and they refuse to do any diabetes education when the insurance companies notify them that the session is for diabetes education only.

Most CDEs refuse to work with people with type 2 diabetes. Considering the numbers of CDEs that work full-time as CDEs, it is not surprising that there are so few CDEs available to work with people with type 2 diabetes.

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