When we're diagnosed with diabetes, we hear about something called a "patient-centered healthcare team," where the patient is supposedly the captain and the endocrinologist, certified diabetes educator, dietician, eye doctor, primary care doctor and other specialists are all supporting team members.
Or so they say. Truth is, "healthcare teams" are rarely set up like this.
As we all know, the patient is rarely in charge of anything and medical professionals are rarely working in harmony. Most appointments involve a long wait, then sitting down for a few minutes, having a doctor quickly look over your meter download or a logbook (which naturally encompasses every nuance of your life - NOT), getting some rote suggestions for how to improve X, Y, and Z, and then being told to make a follow-up appointment in three months. Meaningful lifestyle changes or coping with burnout are not easily addressed in one appointment lasting the typical seven minutes.
It's no secret that we PWDs are suffering from from a lack of support. There are just about 15,000 Certified Diabetes Educators in the U.S., plus about the same number again who aren't certified, but 26 million people with diabetes. The numbers are not exactly in our favor. Plus time constraints, distance and insurance limitations can further hinder our ability to see a helpful medical professional more than a couple of times a year.
That's why the "Diabetes Coach" is becoming a resource that more PWDs are turning to. They're not trained medical professionals, but life-balance experts who may have a lot to offer in helping us cope with our day-to-day D-struggles.
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As we head into the annual American Association of Diabetes Educators (AADE) conference later this week, we're examining this newest potential "team member" and what the Medical Establishment thinks of these "alternative" providers.
What is a "Diabetes Coach" Exactly?
Basically, a D-Coach is a cross between a life coach and a health coach... In other words, they work to help people pursue specific goals by helping them examine obstacles and by providing concrete steps and accountability. In the business world, coaching might involve helping a client develop a small business. In life coaching, it might be a focus on personal relationships or stress management. In health coaching, it's generally goals like losing weight or eating better — which are affected by many "life challenges," of course.
A lot of people mistake life coaching for psychiatric therapy. While there can some therapeutic benefits to coaching, it's distinctly different. One expert explains it this way:
"The psychotherapist is the person who is sought out for healing old wounds, focuses on past issues, and deals with personal problems that need to be analyzed and solved," pyschotherapist Sherry Gaba explained to Counselor magazine. " The life coach, on the other hand, is a mentor or guide. Coaches focus on the manifestation of one's future making their dreams come alive now with accountability and action steps designed both by the life coach and the client."
While educators are trained to teach patients what they need to do to be healthy and manage their diabetes, diabetes coaches are on tap to help their clients figure out how to put those instructions into practice. Diabetes coaches focus more on the nitty-gritty life obstacles. Sounds like the missing link, actually!
Helping You Understand Yourself & Take Action
Motivation is a large component of coaching that stands out when compared to what the other health care team members do. Not that CDEs can't motivate behavior change, but one of the hallmarks of coaching is motivating a client to make positive changes and helping them stick with it. Many D-coaches are PWDs themselves, which can add an extra dose of credibility, trust, motivation and realistic expectation.
Fellow D-advocate Ginger Vieira, a type 1 PWD for 9 years, works in Burlington, VT, as a dual-certified cognitive coach and personal trainer through her company Living In Progress. She coaches people on issues like overcoming emotional eating, learning how to make healthy eating a natural part of life, embracing diabetes management, coping with diabetes-related emotional burdens, and making exercise a bigger priority. Part of that involves self-esteem development and actually teaching people how to exercise, creating programs for both beginners and more advanced exercisers.
"My role in your life with diabetes is completely different than the role of your diabetes educator," Ginger says. "Their primary job is to teach you, to educate. My primary job is to ask questions and listen to your answers, helping you understand your self better. Then we take that understanding and we create a plan so you can take action in accomplishing your goals."
Mark Josefsberg, a type 2 PWD and diabetes coach in NYC, says, "Although I also educate diabetics, I have found that many people know what they should or shouldn't do, but have trouble putting the information into practice, in their own lives. My role is educator, accountability partner, and empathetic confidante."
Although most clients don't see a life coach for therapy, Ginger and Mark say there's an emotional benefit to working with a coach for those living with diabetes. Many of us have felt frustrated, confused and isolated by diabetes, and these coaches can give an added boost to our 24/7 struggle with diabetes.
"What's changed the most about my diabetes management is my attitude towards it," she said. "Instead of looking at diabetes like it's a chore, I think of management as something I deserve. I deserve to stick to my meal plan. I deserve to stick to my workout plan."
Marianne Tetlow, a type 1 PWD and owner of The Diabetes Coach in Scottsdale, AZ, says: "Usually I have walked in their shoes at one time or another and can relate to what they are going through. As such, I can help them find the motivation, confidence and structure to make positive changes in their attitude and behavior to live their best possible life with diabetes."
The Medial Establishment Says...
You might think that CDEs would be completely anti-coaching, arguing that coaches are doing the work of a CDE who has spent years in training. But surprisingly, organizations like the American Diabetes Association (ADA) and AADE aren't anti-coaches, because they recognize that the work can be mutually beneficial to their client's health.
"I think the education part should be done by the diabetes educator but I think in concert, the life coach can follow up," says Marjorie Cypress, the ADA's VP of Health Care and Education. "Coaches can make sure that people are progressing with their goals and be the person between the patient and their physician and educator."
Current AADE President Sandra Burke also believes that D-coaches and educators can complement each others' work. It's not an "either/or situation," and the two go hand-in-hand.
"Along with comprehensive self-management education, diabetes educators coach their patients. The services of a diabetes coach, particularly someone easily accessible to the patient, can complement the work of the diabetes educator," Burke told us.
All three D-coaches we spoke with said they don't make any changes to a PWD's treatment plan, although Mark says he will occasionally provide questions that his clients should ask their doctor or diabetes educator. The coaches see themselves as there to support — not replace — the work of a CDE.
"Anyone can say they are a diabetes life coach," Cypress at the ADA warns. "Someone having diabetes is not a requirement. That's not a quality that I necessarily think would make me hire someone."
While I don't fully agree with that (I think having diabetes is a very important qualification!), but there is certainly more to diabetes education and motivation than just having the disease yourself. For example, I can speak English, but I would be lousy at teaching the language. Most of the diabetes coaches we discovered are PWDs themselves, bringing a passion and an understanding of the challenges of diabetes, but the best coaches will have certification in coaching.
The International Coaching Federation is an organization working to standardize the coaching profession by providing a "seal of approval" for certain coaching organizations throughout the country, similar to accredited universities. Coaching programs all slightly different, but most of them focus on teaching coaches how to conduct motivational interviewing, how to work with the needs of an individual, and build a plan to accomplish goals.
If you're interested in a coach, your first step should be checking to see if a coach is certified through an ICF-accredited program. Next, look to see what other experience or training a coach has. For example, in addition to her coaching certification, Ginger is also a certified personal fitness trainer.
There are no ICF-accredited coaching programs that are specifically designed for diabetes. The Institute for Integrative Nutrition comes close, in that it focuses on diet and exercise, which are important components for diabetes. But the coaching programs focus on motivational interviewing and listening skills for the coach.
Sysy Morales, a type 1 PWD, D-blogger and graduate of IIN, shares her thoughts on the program: "There is a ton of respect for people with different belief systems and situations in life and therefore people are encouraged to coach others with this in mind. We're taught to guide people towards what they know they need to do by listening, asking the right questions, and offering suggestions that are in line with where the person finds themselves at that point in time."
For diabetes training and education, we can look to the AADE's new certificate program for healthcare professionals who want more education in diabetes. The AADE Career Path Certificate Program for Diabetes Self-Management Education is designed to give folks who work in healthcare, but who are not diabetes educators, a structured training on diabetes management. It opens up diabetes education to more folks, although it doesn't confer certification or a degree. A rep at AADE confirmed that diabetes life coaches would qualify to take this program, which is provided completely online. The first level of the program is at a fairly reasonable price of $95. The second level, which is longer and more intense, is offered at $795.
Working with a Diabetes Life Coach
Most coaches work with clients remotely, through phone calls, Skype and emails, which makes it a convenient alternative to a CDE. Usually a coach will work with a client for a set period of time, between three and six months, though sometimes longer or shorter. Many coaches also host in-person group sessions or one-on-one meetings.
"Everyone needs a push or a pull sometimes," says Marianne. "I provide an extra set of eyes, ears, an empathetic viewpoint and a voice of reason that is beneficial to the successful treatment of life with diabetes."
The biggest obstacle for most folks is going to be the price tag, since coaches are not typically covered by any type of medical insurance. Coaching services generally cost between $50 to $150 for each one-on-one session (depending on the length), but many coaches offer packages reducing the per-session cost for a several-month program.
Mark says, "A diabetes coach's role is distinct from the role of doctor, diabetes educator, and friends and family. The diabetic now has two people working on their life instead of just one, so that they don't have to go through diabetes alone."
Not having to go through diabetes alone... exactly!
A diabetes coach might not be able to help you tweak your basal rates or tackle your post-prandial spikes, but if you need your own "You Can Do This!" team booster, a diabetes coach could be for you. Because really, none of us want to feel like we're doing this on our own.