More on AADE Activities

This not an easy topic, but I feel very confident that the article written by ANH-USA is on target. Where the problem in the proposed bill starts and needs change is - (a) IN GENERAL. —Section 1861(qq) of the Social Security Act (42 U.S.C. 1395x(qq)) is amended — (1) in paragraph (1), by striking ‘‘by a certified provider (as described in paragraph (2)(A)) in an outpatient setting’’ and inserting ‘‘in an outpatient setting by a certified diabetes educator (as defined in paragraph (3)) or by a certified provider (as described in paragraph (2)(A)).’’

There is more in the bill than the AADE website shows, but at this point I am not allowed to use it. One of my Senators has told me this and he is stating that at this time, the bill is not scheduled for committee and several attempts to bypass committee approval have met with defeat. Both my Senator and the attorney have stated that it is doubtful there will be action this year on H.R. 1726 and S. 1345.

On September 25, I met with an attorney who specializes in Social Security law. He feels that the landscape has changed. I had a printout of the two bills and he read and reread both and asked if I had any other versions available. After his arrival in Washington DC, and a meeting with several Senators and Representatives he called me on Saturday and stated that I could blog about what I knew, but that he could not say more at this time other than what is in the paragraph above.

The attorney did state that the bills currently on file confirm the article published by ANH-USA. If the wording is not changed, what the AADE told Diabetes Mine indicates they are deflecting the truth.

On Monday Oct 5, the attorney called again and stated he does agree that some wording needs to be added to fairly reimburse CDEs for their time on education. He thanked me for sending a copy of my blogs for Oct 3 and 5 and he is upset by the law in Kentucky and the charge of a misdemeanor for violating the law.

I will continue to correspond with both my senators and my representative to urge them to not approve the version currently on file. It is also no surprise that the members of #DiabetesMiseducation Coalition oppose these bills.

Founding members of #DiabetesMiseducation Coalition include:

• International Association for Health Coaches
• National Association of Nutrition Professionals
• Nutrition Therapy Association
• National Health Freedom Coalition
• University of Natural Health
• Maryland University of Integrative Health
• Alliance for Natural Health USA
• American School of Natural Health
• Institute for Transformational Nutrition

These are all organizations that would be excluded under the changes, plus a few more.

This is speculation on my part, but I think that with all the AADE members and officers that have both the CDE and RD (registered dietitian)(dual) titles may be behind this and the Academy of Nutrition and Dietetics is making its presence felt in the actions of the AADE.

I will make my feelings known about the dual titles and that something needs action to specify that if they are acting as CDEs then they need to clearly state this at the beginning of any education and not stray into nutrition as many are doing. I have spoken about this with one of my Senators and she agrees that it should be one and not both and they should only bill Medicare for one topic and not two as some have been accused of doing.

Information on Monopolistic Health Organizations

When dealing with registered dietitians (RDs) and certified diabetes educators (CDEs) you will often be given bad advice. Not only is this true in the United States, but is full blown in Australia. At least others are blogging about this and letting everyone know about dietitians and how bad they are.

The dietitians in Australia, DAA (Dietitians Association of Australia) are really punishing one that advised a patient to eat low carb. Read this blog and then this blog. Apparently, it is against the law as stated by dietitians in Australia to promote low carb. Her dietitian organization, the Southern New South Wales Local Health District (SNSW Health), has removed her license and banned her from all dietetic activities.

As if this was not bad enough, we have Dr Darren Curnoe writing in The Conversation “that there is plenty of evidence that humans have evolved to eat carbohydrates especially starches. Take the amylase genes which evolved to aid the digestion of starch either in our saliva or pancreas through secretion into the small intestine.” Associate Prof Darren Curnoe is based at the University of New South Wales. See the relationship? It is small wonder that the SNSW dietitian group heavily promotes carbohydrates.

I think those of us in the USA have an advantage as several court cases have stopped medical groups and others from running monopolistic and restrictive organizations. Read this - On February 25, the US Supreme Court ruled that North Carolina’s dental board violated antitrust laws by shutting down hair salons and day spas that offered teeth whitening services. According to the Wall Street Journal, “The decision preserves the power of antitrust enforcers to scrutinize professional licensing organizations, even if they are designated as state-government entities.”

Then with the Academy of Nutrition and Dietetics, Steve Cooksey was able to take the state of North Carolina and the Board of Dietetics and Nutrition to court on freedom of speech grounds, and with the assistance of the Institute of Justice have the court rule in his favor. With the Supreme Court case and this court decision anything put forth by the American Association of Diabetes Educators at the state level should be lost by the state CDE boards.

Therefore, I think if those of us that blog about diabetes and try to educate people about diabetes are put under the strain of criminalization by any CDE state board of diabetes education, we will have the law on our side. This means that the different meal plans (low carb or paleo food plans) are challenged by the AADE or AND, they will be dismissed.

This is good news and hopefully I will have more later.

Know When You Are Receiving Bad Advice

When dealing with registered dietitians (RDs) and certified diabetes educators (CDEs) you will often be given bad advice. You need to learn what some of the bad advice is and how to turn this back on them.

Yes, I can say mandates, mantras, and other platitudes because they are often what you will receive. They often don't properly assess you and try to bully you into accepting what they are telling you.

Recently, two of our members met with a RD/CDE (dual titles) for classes. Sue had not intended to go, but her doctor did ask her to go and report back to him. The other member was Jennifer and she was hoping to hear something more than she had been hearing from us.

When the class started, the emphasis was on whole grains and eating enough carbohydrates to prevent brain damage. Jennifer asked how many that meant and the answer was 45 grams to 70 grams per day. This told Sue that she had to think fast, but the instructor was on to planning meals that would see to it that they consumed enough carbohydrates.

When she finished with this and asked if they understood what they had been told, Jennifer asked if testing showed that they were too high for the blood glucose reading, should they reduce the grams for the next meal? The instructor did not miss a beat, but went right to telling them that if the reading was too high, they should talk to the doctor about increasing their medications or adding another medication.

Sue held her peace for that round as she was planning on dropping the bomb later. Jennifer asked what would be too high a reading and the instructor stated 180 mg/dl. Jennifer said that is in the range that could cause complications and the instructor said not if she was able to add another medication.

Jennifer said then she would need to reduce her carbohydrates as anytime she consumed whole grains; she would spike over 220 mg/dl. The instructor then advised her to have a talk with her doctor as she needed the nutrients found in whole grains.

At that point, Sue felt things had gone far enough, so she explained to the instructor that she was off all medications and eating low carb/high fat as was her husband. That really upset the instructor to the point she said that then she was not diabetic and why was she taking the class. Sue said that she had support from her husband and their support group and her doctor to work at getting off all medications and with the exercise and food plan has been able to stay off all medications.

Sue continued that whole grains are not the end-all and the nutrients could be found in other foods that were nutrient dense and did not have the carbohydrate content. Sue said even the ADA has partially accepted the low carb/high fat food plan which meant that the instructor was following the USDA guidelines instead. Sue concluded that by not encouraging testing and advising more medications that she was a fraud and did not have the best interests of patients in mind, only the interests of the corporate sponsors of the AADE and AND.

With that Sue and Jennifer left. Jennifer was very surprised at what the instructor had said and the way she was pushing whole grains, carbohydrates, and medications. Sue said she was glad Jennifer had asked about testing as most of the time they will not talk about testing and the readings to avoid. Sue said that her pushing medications is not good as this is what causes people to gain weight and often need more medication. The meal plan needs to be such that less medication is needed and if necessary help lose weight.

Jennifer asked how often to test. Sue told her to always test in pairs to be able to see how the meal affected her blood glucose levels. They had arrived at their cars and Sue said she was welcome to contact most of the older members and to ask her questions. They went their separate ways and Sue told her doctor what had happened. He thanked her and said this confirmed an earlier report by one of his patients.

AADE Is Not a Clean Organization

The Kentucky law is similar to what the Academy for Nutrition and Dietetics has passed in several states. It provides exclusive rules for whom may teach education and provides misdemeanor penalties for others providing diabetes education. I am not sure that even doctors are exempt. They are able to practice their profession, but the interpretation will be whether they can do any diabetes education.

Yes, there is a place for interpretation, but it seems that the law is clearly written to make the American Association of Diabetes Educators (AADE) the sole organization for doing diabetes education. It will be interesting to see if the Academy for Certified Diabetes Educators is included or excluded. A lot of authority is centered with the Board of Educators that is appointed by the Governor of Kentucky.

What I find surprising is the fees being charged to maintain an active license.

Pay licensing amounts as promulgated by the board through administrative regulation, with the following restrictions:

1. Initial licensing shall not exceed one hundred dollars ($100);

2. Annual renewal shall not exceed one hundred dollars ($100);

3. Biennial renewal shall not exceed two hundred dollars ($200);

4. Late renewal shall not exceed one hundred fifty dollars ($150); and

5. The reinstatement fee shall not exceed two hundred twenty-five dollars

($225).

(a) Licenses or permits shall be renewed annually or biennially if the board

requires biennial license renewal by administrative regulation.

(b) Licenses or permits not renewed within thirty (30) days after the renewal date shall pay a late penalty as promulgated by the board in administrative regulation.

These are not cheap fees for a CDE only working part-time. Unless this is a way of forcing CDEs to work full time or get out of the AADE.

Admittedly this is my opinion, but in my reading of the information, the AADE is taking actions similar to AND to become the only source of diabetes education. This is something I will oppose in my state as I feel that it is my right to obtain diabetes education where and when I choose and not from CDEs that want exclusive rights to diabetes education.

I see too many emails from people that CDEs are promoting nutrition and not diabetes education. On further investigation, many have had two titles after their names (i.e., CDE and RD). They are promoting high carb/low fat food plans and often the carbohydrate count in 45 grams or higher numbers per meal. This says that they are not allowing low carb/high fat (LCHF) food plans. All have been promoting whole grains, which those of us that do our testing know are the wrong foods for people with diabetes. The ADA is now allowing LCHF food plans, but the USDA is of course promoting whole grains and high carb/low fat (HCLF) food advice.

Most, but not all, CDEs do not promote testing of blood glucose levels other than one time per day and generally only at fasting in the morning if taking oral medications. Those of us on insulin that test more often know that it is necessary to test in pairs to discover how different food plans affect our blood glucose levels. Many of us sacrifice to purchase sufficient test strips to test at each meal, before and after exercise and before bed or about nine times per day, and sometimes we test more often if we feel that hypoglycemia may be happening.

Just a Few Notes on the AADE

I had planned to have more information about the two bills (H.R. 1726 and S. 1345), but dealing with an attorney can be time consuming. In addition, they can be overly cautious and this is probably a good idea on this topic.

After meeting with the attorney (a specialist on Social Security), he felt that I had a lot of information, but because he was traveling to Washington, DC on October 1, he asked me to hold up on my blog until he could read the official papers on file with the two chambers of Congress. If they were identical to the two copies on the AADE website, he would give me information for my blog and allow me to go ahead. If there is a difference, he will send me copies of the differences if possible, and offer suggestions.

He is concerned, but would not say about what or give me any clues. He did ask me to investigate and see if I could find out if any states currently had licensing or funding laws for CDEs on the books and to see if I could find out if they were on the Internet. We are concerned what the law passed in Kentucky says and how it is written, as this will give us an idea of what the AADE is promoting in other states.

I have my work cut out for me and will be busy for the next few days. After doing some research, the task may not be that difficult as there are only two states that have anything on the books. I am concerned about those in Kentucky as the punishment for non-CDEs doing any teaching about diabetes is only a misdemeanor.

It is not stated whether this teaching is for a fee or just writing about diabetes and teaching this way. In other words, it seems open to interpretation and may affect many people that are not CDEs. Sounds and looks like this may be written after the Academy of Nutrition and Dietetics (AND) laws. Time will tell once we see how they react to people writing and blogging about diabetes.

Now Indiana is still in the early stages and is being strongly opposed by the Academy of Certified Diabetes Educators (ACDE), which has introduced a proposed law to reverse the current law and not allow non-CDEs to be taught how to teach about diabetes.

Florida and Pennsylvania are only the two other states with pending legislation at this point. There may be other pending legislation states, but as of yet there are none.

What is AADE Up to Now?

If this is true, what is happening to our diabetes educators? This may be why the project I included in this blog about having Associate Diabetes Educators under the umbrella of the AADE has not been in any notice of the meetings since or even mentioned on the American Association of Diabetes Educators website. Now I will stand by that blog about having concerns about the new AADE leaders.

Could it be that the AADE is trying to outdo the Academy of Certified Diabetes Educators (ACDE) and limit what they can do. This surprises me because of the actions by the ACDE in the state of Indiana when they opposed a law passed by the Indiana legislature to allow non-CDEs to help educate other people with diabetes.

At this point, only the state of Kentucky has passed the bill allowing the AADE to be the source of diabetes education. Like the AND (Academy of Nutrition and Dietetics), the AADE has attempted to create mandatory certification requirements at the state level, but has been almost completely unsuccessful.

Now the AADE seems to be trying its luck on the federal level. A bill before Congress called the Access to Quality Diabetes Education Act of 2015 (HR 1726, S 1345) will make it more difficult for patients with diabetes to get the help they need to overcome the disease.

The so-called Access to Quality Diabetes Education Act (which opponents are appropriately calling the #DiabetesMiseducation Act) would turn this currently voluntary certification into a legal requirement under Medicare, a costly, unnecessary obstacle for thousands of healthcare workers. If passed, this would leave countless diabetic patients without access to important, life-altering services and possibly limit who could educate the diabetes patients about diabetes.

There is something else you need to know about AADE. It is not an independent, objective organization. In fact, it receives large sums of money from Big Pharma. The organization’s 2014 annual report shows that its top two corporate donors were pharmaceutical giants AstraZeneca and Novo Nordisk, with Eli Lilly not far behind.

Diabetes is a rampant, ever-worsening health problem. One recent study found that half of adults in the US have diabetes or are in the pre-diabetes stage. Diabetes is often, but not always, the result of poor diet and lack of exercise. The standard American diet (SAD) tends to create insulin resistance. New studies have emerged showing that consuming highly processed starches is like eating sugar, causing rapid glucose spikes that may over time induce insulin resistance and, eventually, type 2 diabetes.

Conventional doctors often lack the resources to provide much support to diabetic patients. Often they do not have the time to do diabetes education, or they provide seriously misguided information on how to manage or reverse the disease. Health coaches and diabetes educators become particularly important.

And, if the AADE gets this passed, what will happen to those diabetes knowledgeable people that are helping doctors in rural areas? Will they be criminalized? Even scarier is diabetes bloggers; will they criminalize us as well? The future looks very grim and we will be facing two organizations that will be competing to be the only organizations allowed to teach nutrition and to do diabetes education. This will mean that patients will no longer have a choice in learning about diabetes and will suffer because of the advice being promoted by two exclusive organizations.

Because of the AADE leaders that have two titles, CDE and RD after their names, it is not surprising that our diabetes education will take on a new twist – more and more whole grains and more and more carbohydrates. BIG FOOD must be licking their chops with this bill, as well as Big Pharma.

Patients will be advised to consume more high carbohydrate and dense carbohydrate foods and cover their high blood glucose spikes with more diabetes drugs. It will mean that diabetes will become more progressive for the people that willingly follow the advice of CDEs and RDs (registered dietitians). Those of us that have learned the consequences of following this advice know that we cannot go there and need to continue limiting our carbohydrate consumption and increase our fat consumption. Covering increased carbohydrate consumption with more diabetes drugs is not the answer and leads to more overweight people with diabetes.

I have sent my objections to my senators and representative. Read this article for more information. I would suggest that you read this blog by Steve Cooksey.

Is Internet DSME Beneficial?

People with type 2 diabetes can benefit from diabetes self-management education (DSME) and it does not need to be taught by certified diabetes educators. If done correctly and people with type 2 diabetes will learn, the internet can be a great place to learn and sharpen diabetes management skills.

Self-management of diabetes, includes medication, nutrition (food plan), and lifestyle strategies. This is essential for optimal glycemic control and minimizing complications of the diabetes. Education to teach and improve self-management skills is critical for success and, when delivered via the Internet, can lead to better glycemic control and enhanced diabetes knowledge compared to usual care.

“Katherine Pereira, DNP, Beth Phillips, MSN, Constance Johnson, PhD, and Allison Vorderstrasse DNSc, Duke University School of Nursing (Durham, NC), review various methods of delivering diabetes education via the Internet and compare their effectiveness in improving diabetes-related outcomes. In the article "Internet Delivered Diabetes Self-Management Education: A Review," the authors describe some of the benefits of this method of educating patients, including ease of access and the ability to self-pace through the materials.”

DSME delivered via the Internet is effective at improving measures of glycemic control and diabetes knowledge compared with usual care. In addition, results demonstrate that improved eating habits and increased attendance at clinic appointments occur after the online DSME. The researchers discovered that engagement and usage of Internet materials waned over time. Interventions that included an element of interaction with healthcare providers were seen as attractive to participants.

Internet-delivered diabetes education has the added benefit of easier access for many individuals, and patients can self-pace themselves through materials. More research on the cost-benefits of Internet diabetes education and best methods to maintain patient engagement are needed, along with more studies assessing the long-term impact of Internet-delivered DSME.

I commend the individuals involved for realizing that the Internet could help with diabetes self-management education. The increasing numbers of people with diabetes is resulting in limited availability and access to diabetes care services. This includes access to certified diabetes educators. It is estimated that there is about one certified diabetes educator per 1,400 patients with diabetes in the United States. Because of the many factors limiting access to diabetes education, innovative delivery methods for DSME will need to be developed. One potential avenue that has been studied over the last decade for addressing the reach and accessibility of DSME is the use of Internet-based interventions.

DSME as a vital component of the care of patients with diabetes and the ADA recommends that DSME be provided for every patient at the time of diagnosis of diabetes and as needed thereafter. Despite these recommendations and the proven effectiveness of DSME, many patients with diabetes never receive DSME or any form of diabetes education.

If the future plans of the American Association of Diabetes Educators come to fruition, then there may be some hope. With the Academy of Certified Diabetes Educators staying with the exclusive idea that they are the only ones capable of providing diabetes education, we cannot expect any help from them.

The full copy of the report is available to read here until November 6 and then it goes behind a pay wall.

This Is Interesting about the ACDE

I will quote from the Academy of Certified Diabetes Educators (ACDE) to avoid errors and then consider comments.

“Mission

Advocate, through support and awareness, for the professional recognition and advancement of the certified diabetes educator credential, acknowledging the credential’s multi-disciplinary composition, through shared expertise and partnership.

Vision

Recognition of certified diabetes educators by health professionals, government and the community as the expert standard of education and care of people living with diabetes, through raising standards, innovation and awareness.

Purpose

The Academy is organized exclusively for education, scientific and advocacy purposes to support the provision of Diabetes Self-Management Education/Training (DSME/T) provided by Certified Diabetes Educators.”

The mission is laudable, but nothing new. Now the vision would be more valuable if there wasn't so few CDEs. They serve mostly people with type 1 diabetes which is great, but they serve very few people with type 2 diabetes because there are too few CDEs to manage this.

The purpose of the ACDE may give us some insight into the organization and the word “exclusively” may be what we need to pay attention to, as this is the motto of another organization that is working hard to promote their being exclusive to the detriment of other professionals. The other disturbing fact in the purpose is DSME/T. This means that they are not recognizing the change to Diabetes Self-Management Education/Support (DSME/S). This was developed by a Task Force from the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA).

For the ACDE to ignore this means more mandates, mantras, less education, and probably little or no support. To ignore these national standards has me concerned.

The membership categories is also of concern. I will quote them to avoid confusion on my part.

"ACTIVE MEMBERSHIP in the Academy is open to healthcare professionals who are certified by and in good standing with the National Certification Board for Diabetes Educators.

ASSOCIATE/EMERGING EDUCATOR MEMBERSHIP in the Academy is open to healthcare professionals holding a current, active, unrestricted license, registration, or certification from the United States or its territories, or a master’s degree or higher in social work from a United States college or university accredited by a nationally recognized regional accrediting body and who do not meet the requirements for Active Membership.

AFFILIATE MEMBERSHIP in the Academy is open to individuals who provide products and/or services related to the provision of DSME/T who do not meet the requirements for Active or Associate Membership.

STUDENT MEMBERSHIP in the Academy is open to those individuals currently enrolled in an accredited higher education program leading to a degree in one of the NCBDE recognized disciplines or graduate degrees. After one year following graduation from an accredited higher education program, student members must transfer membership to either Associate or Affiliate Membership."

The exclusive requirements I feel will be the downfall of the ACDE and the AADE should be a better education/support organization once they have the non-licensed category of peer-to-peer groups helping them. People with diabetes helping other people with diabetes should be a success. I believe this as I see this in our support group and we have no training.

What Is the Future of the AADE?

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 some 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.

The AADE does have honorary members and does unofficially work with a few of the groups in the last sentence above. And the AADE does not list all that have passed the NCBDE examination as members. The about 13,000 members does become more realistic when you consider those that have retired or are not doing certified diabetes education work. Although neither organization is particularly transparent in their actions, from my observations the AADE is the more transparent of the two.

Now I will take a blog by one of theAADE members posted on the AADE website and discuss the points made in the blog. You may read the points here.

“•We should keep moving forward with our public awareness campaign to increase media exposure highlighting what we do for people with diabetes (PWD). Rather than relying on a healthcare provider to recommend diabetes self-management education and support (DSME/S), let PWD know about what we do so they can ask for a referral (similar to what patients do regarding medications after they read or hear about something new).”

False advertising is not what they should be doing. This is the aim of Big Pharma in their advertising and the hypochondriacs answer the call. There has to be some reason that healthcare providers stop referring diabetes patients to CDEs. I know some doctors do not like the conflicts created by CDEs and this is why many will no longer refer diabetes patients. In other more rural areas, CDEs are just not available. When CDEs teach to the lowest level, make mandates the rule and do little actual education, then we must wonder if they have a purpose. Even many studies find that peer-to-peer education produces better A1cs.

“•When considering the value of diabetes education/educators, recognition should be given to what we prevent including the onset of diabetes, complications from diabetes, and costs (i.e., to prevent hospital admissions).”

Oh, if only this last could be true! The CDEs generally do not work with people with pre-diabetes or counsel them. Very few ever work with type 2 diabetes patients; therefore, I have to wonder with so few CDEs, how can we depend on these people to really fulfill the needs of so many. Most CDEs do not properly assess persons with diabetes (PWD). For many it is a one-size-fits-all or nothing. Many will not work with a PWD that talks about depression and most avoid dealing with depression or burnout. How can patients trust CDEs that avoid something like mild depression.

“•Diabetes education should be at the beginning of the algorithm for care of a person with diabetes; not at the middle or end when problems could have already occurred.”

The above is true, but there are not enough CDEs to take this on. Most will not work with telemedicine or groups of patients.

“•Diabetes educators are key providers in chronic care; we should brand our profession to be included in the chronic care model.”

Diabetes is a chronic illness, but with the few CDEs, how can we depend on CDEs to fill this role. Mandates do not work for people with diabetes and we need individual treatment, not the one-size-fits-all treatment they dish out.

“•Diabetes educators need to be armed with more knowledge on the business of diabetes to help us in the current medical care environment (i.e., Patient-Centered Medical Homes, Accountable Care Organizations, etc.).”

Many CDEs are learning that doctors are excluding them from the new medical care environment because of their attitudes.

“•We need to get legislators on our side to push through legislation that will help us in our work with PWD.”

This statement can be taken several ways and is open for interpretation. We have one organization doing this now and we don't need another organization trying to criminalize people for helping others with diabetes.

“•Diabetes educators can collaborate with more money-generating pieces of medical care so we can give quality care to PWD in a team approach (rather than struggling financially on our own and being considered a money-losing part of care).”

They do have a lot to learn.

“•We should clarify the levels of the diabetes educator so it is understood by us, healthcare providers, and the public.”

What levels are they talking about? The levels of mandates, maybe. Or those that run from people with depression? Now if they have different levels of education and training, maybe we should know this.

“•Many people with prediabetes may not appreciate the importance of behavior change to prevent the onset of type 2 diabetes. Perhaps prediabetes should be renamed Stage 1 diabetes to increase the importance of the condition and changes that can be made to prevent progression to DM (Stage 2 diabetes).”

This is one point I could support.

.
“•We should look for ways to influence the prevention of type 2 diabetes, from children to adults, with methods that can be accessed by all in need (including those with socio-economic challenges).”

No comments.

“•Electronic medical records give challenge and benefit. Diabetes educators should be at the table during the creation of EMRs to improve ease of use and beneficial data output.”

They are a way behind on this one. EMRs have already been created and are being updated all the time.

“•There are not enough diabetes educators to meet the needs of all PWD that could benefit from DSME/S. We need to get the word out about diabetes education in academic programs and to current healthcare providers that might be interested in becoming diabetes educators. At the same time, we need to increase the public’s knowledge of how we can help, increasing referrals to prevent closing of programs (and back to the knowledge about the business of DSME/S).”

The first sentence is correct, and the rest is a pipe dream as some are interested until they find out about the test and the qualifications needed.

Diabetes Cure – Not Today

Excuse me for being blunt, but someone needs to be. When certified diabetes educators with other titles like registered dietitian, we need always to be concerned about which conflict of interest we are receiving. Is it Big Food or Big Pharma that is being promoted? I always take the first title behind the name as being the one of most concern.

That led to a surprise in this blog on the American Association of Diabetes Educators (AADE) website. I had a difficult time swallowing her reasoning for letting a myth take over her discussion. After her class hears the myth, she concluded the blog by asking, “So why is it still so difficult to get patients to “buy in?””

Why she had to ask this, when she answered her concluding question in the paragraph above it, still puzzles me. “Most are looking for that “miracle pill” that helps them lose weight and improve physical abilities while allowing them to eat as much as they want.” It would seem to me that she has more educating to do and very unwilling listeners. I have no sympathy in this case because she allowed a myth to be promoted in a diabetes class.

Yes, I have had people tell me that this is the twenty-first century, so there has to be a cure. I try not to let this go any further and if it does, I say until they can produce the article or advertisement, it is not part of the discussion. I have had one person produce the advertisement and with that, I was able to show the person why and how he had been mislead. No, he was not happy, but after making him answer questions about the advertisement, he had a better understanding. After that, he thanked me for making him decipher the advertisement.

Back to the blog, and why I have a problem with CDEs. Yes, the author did mention diet and exercise, but it was more like a mandate than education. Rather than stretch their brains, many CDE’s resort to mandates and expect people to follow. This is also a reason for lack of buy-in by patients.

I am surprised that the dogma of consuming whole grains was not introduced. That is the only positive I can identify in the blog.

A New CDE Organization – Good or Bad?

A new CDE organization announcing its formation raises all types of issues and makes one wonder what is happening. I'll admit I was perplexed when I read the blog on Diabetes Mine on January 30. I do think changes need to be made in the American Association of Diabetes Educators. However, I question a new organization which will take a few years of get firmly established and provide the services needed to keep up with the epidemic of new diabetes cases.

The new organization is named the Academy of Certified Diabetes Educators (ACDE) and it officially announced its coming on January 1, 2014. Whether this means more or less actual workers to help those of us with diabetes – this is the question to be answered over the next several years. And, will they be better trained, more empathetic, or will there be just more of the same old mantras, mandates, and dogma we have had to deal with from members of the AADE.

There are several issues that need to be put on the table for discussion. The first issue is what prompted my ire in the beginning. The leaders of the American Association of Diabetes Educators (AADE) sat in their ivory towers and lost track of what the educators in the field were doing. As a result, more doctors were disappointed and unhappy with the education not being done.

The second issue is what will one CDE organization do to combat the effects of the other organization. We don't need the tactics employed by the Academy of Nutrition and Dietetics where they have pushed licensure through some state legislatures to make them the only organization able to preach faulty nutrition. Then in some states they have been successful to criminalizing other nutrition professionals. With the shortage of certified diabetes educators, we as patients don't need this happening.

The third issue is conflicts of interest. The ACDE is too young to have conflicts of interest (COI) yet, but the AADE does have COIs. We don't need either organization having these and making their education less effective and transparent.

The last issue is peer mentors and peer workers. The new ACDE organization is promoting only members that have passed the test administered by the National Certification Board for Diabetes Educators (NCBDE). If they are intending to be so exclusive in their education that they limit new members, then they may not meet the needs of people with diabetes.

I like the statement Mike Hoskins ended his blog with and I will quote it, “Whatever the focus, hopefully one thing is clear to anyone working in this field, whether you’re “certified” or part of this or that organization: the key is to do less talking, and more listening to the real-world concerns of patients. In the end, you can have all the certification and titles in the world, but if you’re not effectively connecting with us PWDs, then all is lost.”

I would also encourage you to read the comment by Sheryl Traficano, CEO of NCBDE, about the qualifications to set for the test. These are almost impossible for lay people to achieve even if they have the education in related fields.

I am just thankful that more doctors are realizing they don't have the time for the necessary education and are working with peer mentors and peer workers to fill the gap left unfilled by CDEs. This is important in many rural areas. Thank goodness telemedicine is also coming of age and being accepted.

Can a Certified Diabetes Educator Help You?

This question has many sides and depends on many variables. If you live in heavily populated areas of the United States, your chances are above average that you may find a certified diabetes educator (CDE) that may be willing to help you. If you reside in many of the rural areas, you can bet that you will not find one near you. If you are willing to travel hundreds of miles, maybe, just maybe, you will find one. Whether you have type 1 diabetes or type 2 diabetes will also make a difference as to their willingness to provide help.

I will not hide the fact that I have a bias. I even have a cousin that is a CDE, but I don't talk to her anymore because she has attempted to have me reduce my criticism of the profession. A nurse (CDE) friend of my first wife does still talk to me, but we have agreed not to discuss CDEs and the topics related to the profession. The latest discussion with a CDE was anything but a discussion and became very contentious. She had recommended a certain medication, which is manufactured, by one of their industry allies and I questioned the usefulness since I do take a competing product. Then I commented that she was showing a conflict of interest and the contentiousness escalated.

The endocrinologist asked what the problem was and when I brought up the conflict of interest, he asked if I could prove it. I asked for permission to use the internet and showed him the Industry Allies Council page in the American Association of Diabetes Educators (AADE) site. Since this was not a diabetes medication which the CDE wanted me to change to, I had told the CDE that she had a conflict of interest.

Now I know that CDEs are a great help for many people with type 1 diabetes, but in general prefer not to work with people with type 2 diabetes. The myth even exists that CDEs are for people with type 1 diabetes only. I know that people with type 2 diabetes are seen by CDEs, but not in great numbers. Much of this is because there are not enough CDEs to go around. The other factor against them is that so few have either type 1 diabetes or type 2 diabetes that they have more difficulty relating to us.

The new writer about type 2 diabetes at About dot Com is a registered dietitian, certified diabetes educator. She says, “There are about 18,000 Certified Diabetes Educators accredited by the National Certification Board for Diabetes Educators.” At least this is a distinction from the membership numbers the AADE has on their website; and helps explain that not all CDEs are members of the AADE. In her biographical information, she does not claim to be a member, does work as an Advanced Nutrition Coordinator for the Mount Sinai Diabetes and Cardiovascular Alliance, and served as past editor and board member of the Long Island Dietetic Association. She is certified in Adult Weight Management.

It will be interesting to follow her and see how often whole grains becomes the topic and how often they are promoted.

AADE Membership Numbers and Industry Sponsors

Apparently, I have ignored some of the activities of the American Association of Diabetes Educators (AADE) for too long. The membership has decreased from a reported 13,000 members per the AADE 2012 Fact Sheet to the latest number of 12,000, as shown in the AADE Career Opportunities. Why is this happening? There is no indication on the website and at least they are no longer claiming that their membership is growing as I questioned in my blog here.

I suspect that many have left the organization or discontinued their membership, but I have no proof, as they are very secretive about what compromises their membership. Because I have been critical of their organization, I cannot get anyone to answer an email for further information.

Further exploration of the AADE website confirms that they are continuing to ignore the National Standards for Diabetes Self-Management Education (DSME) and Diabetes Self-Management Support (DSMS) adopted by the ADA and written by members of the AADE and ADA. Another article calls these the Ten Gold Standards for Diabetes Self-Management Education.

These ten National Standards for Diabetes Self-Management Education is designed to define the quality of education and support for diabetics and pre-diabetics. A diverse group of health care providers reviews and revises the standards every five years. There are ten standards that diabetes educators and programs should follow in order to provide optimal care. The fact that the AADE has not adopted them or shown them in their Position Statements for 2013 or their 2013 Practice Advisories says they are not adopting them. Fact is they show no Position Statements for 2013. The AADE is still adhering to their standards for Diabetes Self-Management Education (DSME) and Training (DSMT).

In their Scope and Standards section they do have reference to the fact that the AADE collaborated with the American Diabetes Association to develop the 2012 National Standards for Diabetes Self-Management Education and Support. This is just the PDF file that is a copy of the ADA publication. There is no statement that they are adopted or if they are to be part of the AADE guidelines. I have blogged about the National Standards starting here.

The surprising find on the AADE website is their conflict of interest area in which they list the Industry Allies Council of the diabetes supplies manufacturers and pharmaceuticals manufacturers. The list is more inclusive that I had imagined and explains why certain medications are being heavily promoted by CDEs. This list can be read here.

In the past, I have wondered why the AADE would not establish a classification for lay people to help with diabetes education, especially for people with type 2 diabetes, but now, I will not encourage this with the conflict of interest being known. Instead, I will move my encouragement to organizations already making this happen and encourage medical schools to develop these activities and other higher educational institutions that have developed lay programs in the past.

Presentation to a Group in a City West of Us

I have held this, as I was not sure I even wanted to show what could happen when things go badly. At the urging of Tim and a few others I am posting this after Tim had read it.  This meeting was on the third Friday.

This was an unusual meeting. I was the only person originally scheduled and one of their doctors refused to attend with the rest of our group in attendance. In a phone call, I was able to determine that the doctor did like others being part of the meeting.

Once the meeting started, a CDE objected to the topic and felt we were not presenting it properly. We had not distributed the email copies; therefore, at that point I stopped presenting. I walked over to their doctor and told him I would be stopping with the CDE constantly interrupting. He asked the CDE to take over. When she did, almost all the members got up and left. I told those with me that we would be leaving as well. The doctor leader of their group asked people to stay, but most said no and continued leaving.

I explained to our group after we were on our way home what had happened to the group originally and that I may have caused the group to disband a second time. This I did not like, but I have had problems with her before and I wanted no more of it. I said I don't like what happened this evening, but felt that the other doctor had set this up and that was their problem. I told the others that I would not be going back and would not participate again until the other doctor has been removed and the group is open to others or groups of presenters. I said, we have had success with other groups and I will not be part of a group that discourages presenter groups.

The following Monday, I received an email asking me to return. I said no and that I did not like being called out by a CDE who was not part of the group in the first place. The answer was that she had not been invited, but had shown up at the request of the second doctor who was not in attendance. I said that I was sorry, but I would not be caught in further conflicts that had caused the group to disband originally and if I had caused this, I would not be coming back.

Tim, our local doctor, and I stayed in touch as we expected further emails and attempts to have one or more of us back. The doctor in attendance and Tim had exchanged emails with the doctor there, we were concerned about why we have been very successful with some groups, and this group was difficult. Tim was surprised that the meeting had ended quickly and quietly. I told Tim that very few have an interest in CDEs and they were not willing to listen to one. I said the group of us had received approval and to have one doctor throwing a fit and getting the CDE involved may have disbanded the group.

Tim commented that this could be the case for our group, but he hoped we would be more polite. I said some may be, but I would be one to leave and do it promptly. I told Tim that even if it was one of my relatives, I would still leave. Tim asked why I would do that. I explained that until the AADE lowered to the bar, created a group for peer mentors and peer workers, and did not constantly push for their own line of education and making it exclusive to their members, I would not wish to have much to do with them and their poor attitude about people with type 2 diabetes.

Tim agreed that setting up education for peer mentors and peer workers would be a positive as long as the AADE did not make it too burdensome and discouraging for people to attempt.

Healthy Plate By Joslin, Maybe Not So Healthy

If you are a follower of the ADA food plan, you will enjoy the Joslin healthy plate. If you need to gain some weight, you will love the Joslin healthy plate. Does this tell you what you need to know about the Joslin healthy plate?

It is not as interactive as a person would like and in fact is rather rigid in options, as you would expect a registered dietitian to be because of being a proponent of BIG Food. I attempted to get a variance to help with weight loss, but everything I tried came up the same when I wanted Joslin healthy plate to do the calculations. If I were to follow the plan, I could figure on gaining approximately 5 pounds per month. Some weight loss plan!

Even using a meal plan that you may have and then following this route would not let you have fat or products containing fat. This shows that unless you use their high carbohydrate – low fat (HCLF) foods, you will not even be able to have a balanced meal that you might like to eat. Yes, those with diabetes that are able to consume the HCLF without causing spikes in their blood glucose levels can eat this. For the majority of people with type 2 diabetes, the Joslin healthy plate food plan will not be one that you will find satisfactory.

I can only surmise that the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) has been more influential in reminding their members to follow certain guidelines instead of allowing any deviation from positions not supported by BIG Food.

While the American Diabetes Association (ADA) does now support other food plans including low carbohydrate – high fat (LCHF), the AADE and AND will not allow what the ADA allows. These two groups will continue to loose support among the patient population for their rigid position.

Why Do Studies Use Patients with High A1c's

The last two studies that I have become interested in have used patients with A1c's above 8.0% or above 183 mg/dl (10.2 mmol/L). To me, this is scary and frightening. Maybe I should not even write about this. These people are 1) not receiving education, 2) have received bad education, 3) not receiving support from their doctor, or 4) don't care to manage their diabetes.

Even this last study amazes me in that fact that the peer coaches had A1c's of less than 8.5%. This may have been the surprises, as they may not have expected the drop they received from the peer coached group. The number of peer coaches numbered 24.

Before the study it was stated the coaches had to be recommended by their primary care physicians and received 36 hours of training over 8 weeks. This was based on a curriculum that included instruction in active listening and nonjudgmental communication. Also covered was helping with diabetes self-management skills, providing emotional and social support, assisting with lifestyle change and medication understanding/adherence, and accessing community resources.

Again, the study number was small with almost 300 participants selected. They were randomly assigned to receive either coaching or usual care. Why the patients were assessed using questionnaires is not understood. They also received a clinical evaluation at the start to establish a baseline and again at six months.

At baseline, the patients in the peer coaching group had a mean HbA1c of 10.1% for the 148 patients. At six months, the peer coached group had a mean HbA1c of 9.0% or a drop of 1.1%. Also the peer coached group had 22% with HbA1c's below 7.5%.

Now compare this to the usual care group. The usual care group numbered 151 patients and had a mean HbA1c of 9.8%. At six months, the mean HbA1c was at 9.5% for only a decrease of 0.3%. Only 8% in the usual care group had HbA1c levels below 7.5%.

This is significant even with a small number of participants. And yet, the American Association of Diabetes Educators continues to discourage lay people and won't open a class for them and provide any training. Think what could be the potential benefit for millions of diabetes patients not being served currently by the AADE.

AADE – Is It Heading In the Right Direction?

According to Tami Ross, the current president of the American Association of Diabetes Educators (AADE), writing a comment to a recent blog in Diabetes Mine - “Second, contrary to the assertions raised, membership in AADE is not shrinking. In fact, membership has grown by more than 20 percent in the past 4 years.” If this is true then the membership numbers should have changed in the last four years, but unless there is a lot of secrecy behind this, their information published first on their home page and now in their fact sheet shows they have not had a membership increase in at least the last three years. The AADE Fact Sheet states, “With more than 13,000 members, AADE advocates on behalf of diabetes educators and the patients they serve.” To see this you need to download it with a PDF compatible reader and currently is the first item under the tab ABOUT US.

A 20% increase should have meant they had a membership increase by at least 2,600 new members. In any calculation, this means 13,000 plus 2,600 equals 15,600 members. This means somewhere in their calculations, growth has been stagnant, or the numbers had been inflated in the past. Why would they claim a 20% growth and not reflect this in their own membership numbers?

Then Tami Ross states, “First, to be clear, as it appears there may be misunderstanding on Diabetes Mine’s part, AADE is not a patient advocacy organization. As AADE’s name reflects, we are a professional membership organization for diabetes educators – an organization whose objective and mission is to support the needs of diabetes educators.” Their own fact sheet must be in need of revision then as in the above italicized statement in the last sentence of the first paragraph clearly states the “AADE advocates on behalf of diabetes educators and the patients they serve.” If we are to believe Ms. Ross then the only patients they serve are those that are educators. Sorry Ms. Ross, you can't have it both ways. Please correct your site's Fact Sheet if you do not agree.

This would also explain why the AADE has published nothing about the National Standards that they worked on with the American Diabetes Association (ADA) – the officers of the AADE know they can't live up to them. I have stated this before and I have even more reason to believe this now – Those at the headquarters (ivory towers) are not aware of what is happening in the trenches where mantras, mandates, and platitudes are the rule of the way business is accomplished. I have met certified diabetes educators that do not know what the word assessment means, except that they teach to the lowest common denominator and teach very little.

The AADE Fact Sheet also includes this statement, “Our mission is to drive practice to promote healthy living through self-management of diabetes and related chronic conditions.” From experience, I cannot agree, as I have found very little self-management of diabetes taught. I have experienced only mandates and mantras. Fortunately, I was able to use the internet and discern for myself how to self-manage my diabetes. And being on insulin as a person with type 2 diabetes, I was fortunate that the diabetes clinic became available to me and has an endocrinologist and nurse practitioners on staff.

The nurse practitioner that I was seeing confirmed my own self-education and kept encouraging me to learn. As a result, I have not needed to listen to any additional mantras and mandates from certified diabetes educators.

If professional organizations wish to have strictly internal documents, so be it. Then they need to become thick skinned when slammed for what they do make public. We need transparency, not whining when they are criticized for something that is public. We do realize that most professional organizations are for the preservation of the profession and not directed at the patients. But when whining and complaining become the way of doing business, we must wonder if the organization is worth the money.

National Standards for DSME and DSMS - Part 6

Part 6 of 6 Parts

The standards are very well thought out in general and I can support them. There are several areas that need emphasis. The first is, “In the course of its work on the Standards, the Task Force identified areas in which there is currently an insufficient amount of research. In particular, there are three areas in which the Task Force recommends additional research:

1. What is the influence of organizational structure on the effectiveness of the provision of DSME and DSMS?

2. What is the impact of using a structured curriculum in DSME?

3. What training should be required for those community, lay, or peer workers without training in health or diabetes who are to participate in the provision of DSME and to provide DSMS?”

I mentioned this in Part 1, and I will cover more of this now. If you have not read the standards yet, please consider doing so. These were published back in September of 2012, but not on the ADA site until January 2013. This is the better read as it can take you to each standard, it has links to research papers, and the AADE website is a download of a PDF file and no active links to research papers. As of this writing, the American Association of Diabetes Educators (AADE) has not seen it necessary to correct prior publications or update those on the books for 2013. The AADE has written about their goals for 2013 to 2015, but did not mention anything about the national standards. This may be read by downloading a PDF file at this link, named the 2013-2015 AADE Strategic Plan.

This plan is mainly a generalization of self improvement for those already in the educator field and some general ideas for expansion. This means keeping their control of the educator field and not bringing in lay people to assist them in any way. With the continued shortage of CDEs, how is this any help to the expanding number of people diagnosed every day with diabetes.

I doubt there is any structured curriculum for DSME and what may exist is still thought of as DSME and DSMT. There is nothing presently for DSMS. In attempting to follow discussions and locate DSMS information, you will need to read DSMT (diabetes self-management training).

If you are looking for information on community, lay, or peer workers without training in health or diabetes who are to participate in the provision of DSME and to provide DSMS, you will not find anything. This is only on the books in the American Diabetes Association link above and as of yet, the AADE has rejected publishing any material about it.

What ever strengths or weaknesses exist in the current standards will need to wait until the next Task Force is activated in probably the fall of 2016. If the new regulations put forth by the Affordable Care Act create unforeseen problems for the ADA and AADE then we might see it happening sooner. The past Task Force was activated in the fall of 2011 and most of the material made public in September of 2012. Final publication did not happen until January of 2013 for most material.

“Members of the Task Force included experts from the areas of public health, underserved populations including rural primary care and other rural health services, individual practices, large urban specialty practices, and urban hospitals.” It is good to see that the underserved populations were included; however, I think that the elderly were not part of this underserved group. The following two paragraphs are important enough to quote as they do mark a point of change and an extremely large area that the AADE may not be able to meet.

“The Task Force made the decision to change the name of the Standards from the National Standards for Diabetes Self-Management Education to the National Standards for Diabetes Self-Management Education and Support. This name change is intended to codify the significance of ongoing support for people with diabetes and those at risk for developing the disease, particularly to encourage behavior change, the maintenance of healthy diabetes-related behaviors, and to address psychosocial concerns. Given that self-management does not stop when a patient leaves the educator’s office, self-management support must be an ongoing process.”

“Although the term “diabetes” is used predominantly, the Standards should also be understood to apply to the education and support of people with prediabetes. Currently, there are significant barriers to the provision of education and support to those with prediabetes. And yet, the strategies for supporting successful behavior change and the healthy behaviors recommended for people with prediabetes are largely identical to those for individuals with diabetes. As barriers to care are overcome, providers of DSME and diabetes self-management support (DSMS), given their training and experience, are particularly well equipped to assist individuals with prediabetes in developing and maintaining behaviors that can prevent or delay the onset of diabetes.”

The last paragraph before the definitions covers something many CDEs may not want, but is important. It is the risk for comorbidities (that is – heart disease, lipid abnormalities, nerve damage, hypertension, and depression) and other medical problems that may affect or interfere with self-care. What I find most intriguing is this statement - “The Standards encourage providers of DSME and DSMS to address the entire panorama of each participant’s clinical profile.” These may be some of the areas many CDEs are least comfortable and will not be able to use mandates to bypass.

This is where these standards become important for the patient to learn and be somewhat knowledgeable about to hold CDEs to providing high-quality education and support.

This information is from the National Standards for DSME and DSMS.

AADE Blog on BG Monitoring

If only this could be true! This blog by Carla Cox on the American Association of Diabetes Educators (AADE) website is the most positive blog about the supposed changes made by the American Diabetes Association (ADA) 2013 Guidelines. As research has shown by my blog here, 2013 may not be the year for much change, but maybe some of the results will be heard by the people at ADA and maybe for 2014, we will see some real change in the language and action by the insurance companies.

This quote from her blog is somewhat gratifying, “Benefits of monitoring have not been consistently demonstrated when patients with type 2 diabetes are on lifestyle-controlled regimens or oral medications (The Diabetes Educator, 2007; Health Technology Assess, 2009). Data aside, I believe all of us have seen how much patients learn about their BG response to meals, exercise and environmental pressure when checking BG values throughout the day, regardless of whether it’s controlled via lifestyle or medication. This is with the caveat, of course, that they understand how to interpret the results.”

It seems that the author is calling for more testing by type 2 people and education is what is needed. I could almost believe the good intentions, if certified diabetes educators (CDEs) were working heavily with type 2 patients. We know this isn't happening because there are not enough CDEs for this to become a reality. CDEs currently have no incentive to work with type 2 patients, as being reimbursed is a problem.

Even their own practice advisories from 2010 found at this link under 2010 says the following - “Shared medical appointments (SMA) are a healthcare practice approach that provides more access to patients while using existing resources. SMA are a recognized approach that have been shown to provide high quality care at reduce costs. While insurers may recognize these as separately reimbursable appointments, Medicare has yet to provide guidance on the topic.”  You will need to download the "Shared medical appointment" advisory with Adobe Reader (or another PDF viewer) to view it.

With many type 2 patients being under Medicare, I can understand that they do not wish to take on groups of people with type 2 diabetes as part of SMAs. Not all insurance companies are on board with reimbursing for patients not yet on Medicare. Therefore, in the meantime they will need to contact providers to see if they cover this. Most CDEs are not interested in contacting a variety of providers, as they would prefer a one on one situation. Yet, with the current shortage of CDEs, something needs to change. This says nothing about the needs of people in the “at risk” category (prediabetes) that receive no help.

Another factor that makes me question the sincerity of statements made by CDEs if the fact that Medicare is moving to more preventive medicine and this would seem to be the time for AADE to lobby the Centers for Medicare and Medicaid Services (CMS) to reimburse for SMAs as this could be a giant step forward to educating groups of people with type 2 diabetes and even many in the “at risk” group. Then for the enterprising CDEs, telemedicine may open up doors for education as well. Unless AADE attempts to open these avenues and pressure CMS to reimburse for these avenues, all I can say is the “feel good” hype is worse than BS, and I'm not talking blood sugar.

I sincerely wish this statement could be relied on and trusted - “Blood glucose monitoring is a cornerstone of diabetes education. Blood sugars shift throughout the day and often get progressively higher over time even in the “best” patient with type 2 diabetes.” The bold is my emphasis. I know from experience that this statement sounds good, but when mandates take place instead of education, it ruins the experience for most patients with type 2 diabetes.

This statement in the last paragraph of her blog gets my hackles up, “As diabetes educators, we are the “go to” persons to help guide patients to understand their BG results and to learn to act on the results to help normalize blood sugars and reduce risks associated with frequent BG values that are out of range.” But, how can we “go to” CDEs when they are not available and most don’t deal with type 2 diabetes people. I have to question where the CDEs are and why I should not consider statements like this, “feel good” hype?

AADE's Seven Self-Care Behaviors Handouts

The American Association of Diabetes Educators has seven self-care behaviors handouts. As handouts go, they are too short and missing a lot of information. They did do a good thing by having them in Spanish, but not directed to any specific dialect.

Since I am not a member of AADE, this may be the reason I am not able to download any of the handouts. I can save them as individual PDF files so that I have them available when I need them, so this may be what they are talking about. Not the most intuitive. However, I have not found a way to download all of them at once.

In her article on Diabetes Health, Donna Tomky did lay out a good definition of the seven self-care behaviors handouts. So I will repeat them here:

“Healthy Eating - Learning to make healthy food choices by paying attention to nutritional content and portion sizes
Being Active - Recognizing the importance of physical activity and making a plan to start moving today
Monitoring - Learning to check, record, and understand blood glucose levels and other numbers important to diabetes self-care
Taking Medication - Remembering to take medications as prescribed and understanding how they affect the body and diabetes management
Problem Solving - Gaining skills to identify problems or obstacles to self-care behaviors and learning how to solve them
Reducing Risks - Understanding the potential complications associated with diabetes and taking steps to prevent developing them
Healthy Coping - Developing healthy ways of dealing with challenges and difficult situations related to diabetes”

I was intending to do a blog on each of the items above, but after reading and rereading them, I will only put myself in a depression writing about them. It is depressing enough reading them when one realizes the opportunities lost in providing educational value in the handouts. Yes, there is some quality information, but since this is only a website and they cannot bill a reader, I can understand why there is so little information.

Why does the AADE have to misrepresent the USDA plate and leave the cup for milk completely off? Yes, I disapprove of the USDA plate because it is done to promote agricultural products heavily, but its use on this site leaves it completely unbalanced.  Nutritional balance is sadly lacking in the USDA plate, but I am appalled by the way the AADE represents it at the end of the “healthy eating” handout – unhealthy is the best word I can use for print.

Please take time to explore the handouts here.