Diabetes educators who do less talking, and more listening to the real-world concerns of patients? That's something I think we can all rally around! So we're pleased to report that this was a running theme in all the sessions our team attended at the 2012 Annual Meeting of the American Association of Diabetes Educators (AADE), which just wrapped up this weekend in Indianapolis.

Team members Allison Blass and Mike Hoskins report that at this giant training forum for thousands of the country's Certified Diabetes Educators, there was a bigger emphasis than ever on "individuality" among patients, how to better listen to their concerns, and how to utilize coaching techniques like "motivational interviewing" to get patients moving with lifestyle changes on their own terms. There was also a greater concern than ever for: What are patients saying outside of our offices? Hallelujah to that!

As PWDs, the fodder of many of the sessions about patient concerns seemed like sort of a no-brainer. For example, one presenter said: "With diets and fingerstick testing, we're asking people to stop doing what they like and start doing what they hate." We patients can only nod our heads and chuckle.Yet in our eyes, the recognition of what diabetes does to someone's life outside the clinic at this big formal conference for healthcare professionals is actually a huge win!

Held at the Indiana Convention Center in downtown Indianapolis, this year's event drew just about 3,000 educators.

News nuggets from around the diabetes community

NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
Snail Uses Insulin to Poison Fish
New study shows these slow-moving creatures use toxic form of insulin to capture prey.
A New Square Patch Insulin Pump
Israeli company developing new reusable square insulin pump that has Bluetooth for smartphone communication.

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Thanks to Mike and Allison, here is our wrap-up of what was new and hot at AADE this year:

AADE President Sandi Burke from the University of Illinois College of Nursing in Chicago opened the conference by saying diabetes education is at a crossroads and partnerships with other educators and D-industry professionals are critical. The organization is now in the second of a three-year strategic plan, with a "trend and change examination" finished in late 2011. Now, the group wants to create an AADE Knowledge Center that would allow for more expanded education and training for all levels of CDEs. (We give that a thumbs-up!!)

Along with the talk-less/listen-more theme, across the board CDEs were being encouraged to focus on the positive, not the negative as a way to make a greater impact with their patients.

Instead of focusing on missed targets or incompleted goals, CDEs should call attention to the positive things a PWD has done, even if those changes are small, according to well-known CDE and family therapist Janis Roszler. Otherwise, patients might become discouraged, she says. (Ya think?! Again, we are grateful that this is what educators are finally being taught.)

Technology Talks

For the first time this year, social media and new connected technologies took center stage. Well, maybe not Front & Center Stage, but about 13 of the total circa 100 sessions focused on these topics, which is a whole lot compared to years past. The topic of technology tools was also weaved into countless other discussions happening at the conference.

A Friday afternoon session on mobile health featured a three-person panel including Malinda Peeples, VP of clinical advocacy at WellDoc; D-Mom Pam Henry who created MyCareConnect.com; and CDE Donna Rice from Michigan who's a past AADE president. While the bulk of this talk was way too jargon heavy and didn't really tap into what educators can do to discover new apps and social media themselves, the presenters had some interesting nuggets:

While there are now more than 10,000 health-related apps available on Droid and iPhones/iPads, Peeples said that mhealth is evolving from "just a bunch of apps" to tools that actually provide useful communication for integrated care. She believes that new mobile health tech provides "an opportunity as big as the introduction of home glucose testing." It will fundamentally change the way diabetes care is handled moving forward — via new and more comprehensive ways to view our data, more engagement patients and providers outside clinic opening hours, and hugely increased access to CDE knowledge.

But for the moment, her astute observation is that "diabetes data is plentiful, but not actionable." The FDA allows apps that store and display data, but they're not yet allowed to offer any actionable advice on treatment. The industry is holding its breath for this to change. The FDA is currently looking at draft mhealth guidelines and a public comment period is open now, in case you'd like to chime in!

In all the techy-sessions, CDEs expressed common themes about their concerns: not being reimbursed for time spent using tech apps, patient privacy issues, liability of acting or not acting on data they might receive, the overall impact social media has on a PWD's management and A1C (they're struggling to understand it), and just the amount of online information that can be overwhelming in the little time they have left over after a long day in the clinic. These are all legitimate concerns, but our opinion is that using mobile health apps is going to become mainstream — period — whether sooner or later.

Hello, Social Media

On the theme of listening more, the collective speakers seemed to start understanding that they just can't fight social media use because that's where most of their patients are turning for answers and support outside their practices.

An example of this recognition is the fact that the "AADE in Practice" publication for Summer 2012 sports a front page article by our own Diabetes Advocate and CDE Hope Warshaw, who talked about blogging and how CDEs in practice should embrace it. (Note that a screenshot of the 'Mine is on the cover — woot!)

This year for the first time, there was not just one, but TWO full sessions devoted to how educators can use social media in their own practices.

Hope was the host of the Saturday session that I spoke in, along with Manny Hernandez and David Edelman called "Power Your Practice in Our Socially Networked World." We had a great reception by educators looking to make good use of Facebook, Twitter, blogs, etc. to connect with their existing patients and also attract new ones.

CDE and PWD herself Jane Dickinson moderated our session, which focused on the exciting things the patient community and greater diabetes community have achieved online. One astonishing tidbit Manny mentioned is that there are apparently over 45,000 diabetes-related blogs out there (not sure where he got this statistic - hard to believe!). Hope highlighted some CDEs already successfully using social media: Claire Blum, Iris Sanchez, Jill Weisenberger, Kit McKinney, Michelle Litchman.

Later on Saturday, CDE Susan Collins followed up with a basic Social-Media-101-style session. Many attendees expressed being nervous about social media use in their practices and questioned the need, but one CDE stood up and offered her own case study of expanding her reach with patients. It was an interesting experience tweeting from the session and seeing some of those notes appear on screen in the live twitter feed displayed, plus seeing some DOC friends and initiatives (like #dsma, Diabetes Advocates and the recently-created You are Beautiful/Glasses video) featured in the presentation as examples of high-impact social media use.

Overall, we're very encouraged by the way the AADE is embracing social media these days — a monumental change from just a few years ago when they didn't even recognize patient-bloggers as legitimate attendees of this event. Now we're embraced as press representatives with a vital function of reporting back to our audiences.

Food, Fun & Fuzzies on the Floor

There was a lot to take in on the Exhibit Hall floor, and sadly photos were prohibited for the most part. We were excited to stop by the Diabetes Advocates booth where several friends and fellow patient advocates were telling educators about our online universe... including Manny who managed to advocate so much he sprouted some blue hair!!

Just like at the American Diabetes Association's annual conference in June, every imaginable sort of diabetes company and many D-organizations and programs had a presence. In terms of products, nothing truly new caught our eye, but it was pretty fun to see Medtronic's Build-A-Bear setup, where attendees could get their very own Lenny the Lion stuffed and accessorized. OneTouch also had a stuffed giraffe to offer, though a couple different reps indicated the animal didn't have a name and really didn't serve any purpose other than marketing their booth (lame). There was also a booth where DiabetesMine Design Challenge winner Jerry the Bear could be found!

Food is more a highlight at this conference than at ADA, being that educators have more of a focus on diet and nutrition than physicians do. Allison will be examining some of the food products on the floor this year in an upcoming post, but one highlight worth mentioning is that we saw two new types of low-carb frozen yogurt that might keep you cool during the summer months! Oh, and Crystal Light has some new "sugar-free" candy, although it unfortunately is loaded up with 28 grams of sugar alcohols (boo!)

AND... there's something else food-related we just can't ignore!! We saw a booth that knocked our socks off... and we had to ask ourselves WTF? The High Fructose Corn Syrup lobby gets a booth at a diabetes education conference?!

We snapped a photo and tweeted it, drawing the ire of many in the DOC who also couldn't believe that the Corn Refiners Association was allowed to participate. Two DOC friends who specifically took an issue here were Kelly Kunik who's been a vocal advocate against HFCS for years, and D-Mom Leighann Calentine, who in reaction has launched a new awareness campaign, for Aug. 25 against HFCS.

We asked AADE spokeswoman Diana Pihos about the process of evaluating exhibitors for the conference, and she told us: "While I know we have rejected some exhibitors, we don't necessarily shy away from controversial topics. They can present their case and let the attendee decide what to think."

Hmm.

Not everyone felt outraged by this booth, of course; some attendees said they actually appreciated having the booth there, so they could learn for themselves and decide whether HFCS is healthy and appropriate to recommend in their practices.

We hope to further explore the issue of just how the final exhibitor list is approved for conferences like these, so stay tuned for that.

In Other News

  • Don't Call it a Party... Some "customer appreciation events" are held, and the bottom line is that these events are parties. There's the OneTouch/LifeScan "Irish Coffee Event" attended by many that featured a country singer, and also two others by Roche Diagnostics and Tandem Diabetes that had "Dancing With The Stars" themes. These latter two were focused on encouraging fun ways to get people more active and weave exercise into their worlds. Some of our DOC friends had a chance to make it to these, and even had a chance to show off their moves on the dance floor with a certain celebrity from "Saved By The Bell"!
  • Learning the Law of the Land: The new U.S. Supreme Court ruling on the Affordable Care Act (ACA) came up a handful of times in sessions and discussions about how it will impact not only PWDs but also educators. After the first day of the conference, we chatted with some AADE members who serve as legislative coordinators throughout the U.S. and were a part of state advocacy training. An interesting tidbit involved Essential Health Benefits, (basically a list of 10 broad areas of items and services covered under the comprehensive law) and how no one really understands right now exactly how insurance companies will cover these benefits at the state level. No legal definition exists for the diabetes educator and there's no licensing process outlined, so CDEs might not be reimbursed for providing certain care to us PWDs. In response to all this healthcare reform, the AADE is working on a state licensure initiative.
  • Overheard on an elevator: Once the doors shut, we caught the last part of a conversation between a small group of people with educator-specific letters behind their names, saying: "Diabetes coaches are a JOKE." Obviously, the ladies saying this and nodding their heads hadn't read the official AADE stance mentioned in our post recently...
  • Behavioral Change & BGs: Some of us might get prickly at the notion that our blood sugars affect our behavior, but Eliot Lebow, a psychotherapist and fellow type 1 PWD presented several case studies from his own practice showing how high blood sugars and low blood sugars can indeed affect cognition and behavior. We're not talking behavior as far as healthy living choices here. This is about how out-of-range blood sugars in class, work meetings, and doctor's appointments can change how a person handles a situation. Blood sugars can cloud thinking and slow down reactions. As Eliot explained, it's not productive to educate a patient who is so distracted by his blood sugar levels that he can't focus on the appointment.
  • Distress and Depression Aren't the Same: We know that PWDs are at a higher risk for depression, but did you know that not everyone who is frustrated, angry or overwhelmed with diabetes is depressed? Most of us are simply distressed. Martha Funnell, RN, CDE of Michigan Diabetes Research and Training Center, explained that distress has a higher prevalence than clinical depression, and is significantly more persistent over time. CDEs need to look for diabetes distress as well as depression, and learn how to work with patients to minimize it by discussing the particular times when PWDs feel most overwhelmed with managing diabetes. Instead of just educating patients on what they need to do, CDEs need to be aware of how those tasks affect them emotionally!
  • Entrepreneurial CDEs! Most of us probably see our CDEs in a clinic. But more and more diabetes educators are exploring the concept of entrepreneurship. Gary Scheiner, CDE, type 1 PWD, and owner of Integrated Diabetes Services (as well as a favorite face around the 'Mine) spoke about his experiences owning his own private diabetes education practice. Pros for entrepreneurship include flexible schedules, no hospital bureaucracy to deal with, and -- surprisingly enough -- job security. Gary said with budget cuts at so many clinics, jobs for diabetes education can be at risk. Unfortunately, most private CDEs aren't covered by health insurance, so it can be an expensive alternative for patients.
  • Graduate Programs for CDEs: Many CDEs have advanced degrees in nursing and nutrition, but until recently, there haven't been any specific Master's degrees for diabetes education. Columbia University and Capella University now have Master's programs designed specifically to prepare people to teach about diabetes education and management. CDE Jane Dickinson spoke at AADE about the new program at Columbia University, which is designed to take diabetes education to the next level, and prepare CDEs for training other educators. Currently the program is run independently as an extension to Columbia's School of Nursing, but Dickinson is hopeful that these diabetes management classes might someday become an integrated component of the nursing school.
  • Indianapolis Tweet-up! DSMA Founder Cherise Shockley organized a meetup at the beautiful Indianapolis Arts Garden inside the Circle Center Mall skywalk, and a couple-dozen D-bloggers attending the AADE and others from the area got together to hang out for a few couple. Indy resident Mike was there, and had a lot of fun taking some time out to chat with new and old friends among all the conference flurry.

All in all, our team was glad to be on hand to observe what CDEs from around the country are seeing and hearing about what's new in the diabetes world. It seems AADE is slowly but surely embracing our networked world.

Thanks to Mike and Allison for their excellent reporting!

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