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complaints about CDEs that give outdated advice or that do not work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.
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