Who's Your Diabetes Guru?

Do you have someone committed to helping you get your blood sugar under control and keeping you on track during Girl Scout cookie season? If not, it might be time for you to get a diabetes education from the professionals.

Speaking to Healthline from the floor of the AADE meeting, Charles Macfarlane, AADE’s CEO, said, “We have 14,000 AADE members, and 2,500 of them are attending our annual conference. Diabetes educators bring a true passion to everything they do, and it shows.”

The four-day conference, held August 6 through 9 in Orlando, featured a session on healthcare reform and how it has changed diabetes education and the delivery of primary care. In addition to a host of information sessions and workshops, the meeting also included an exhibit hall with information about new diabetes drugs and the latest high tech monitoring gadgets.

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What Do Diabetes Educators Do?

Diabetes educators help patients manage their diabetes on many levels. “Diabetes is a chronic condition and it needs to be managed daily. We have what we call the 'AADE7 Self-Care Behaviors' framework, which includes seven behaviors: healthy eating, being active, monitoring blood glucose, taking your medication, problem solving, reducing your risks, and healthy coping. We try to frame the conference around those seven self-care behaviors,” said Macfarlane.

Diabetes is a complex condition and self-management can be an uphill battle. "Patients can’t just take medication and then go about their day,” explained Macfarlane. “If you are taking insulin, you have to be thinking, how will exercise, your activity, and what you are eating impact the effectiveness of your insulin? Our members help patients to do that."

The AADE has been around since 1973, and while the number of members has been increasing in the past 20 to 25 years, growth has been particularly noticeable in the past few years. Last year, membership grew by almost 4 percent, and in 2012, membership rose 7 percent. The National Certification Board for Diabetes Educators (NCBDE) has certified about 18,000 educators so far, according to Macfarlane.

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“We continue to see an increase in the number of people who have diabetes, both diagnosed and undiagnosed. We are also seeing more focus being given to prediabetes. Seventy-nine million people in the United States are estimated to have prediabetes," Macfarlane said. "Diabetes educator is a growing specialty that allows professionals to engage with their patients in a slightly different way. It’s not a one-time interaction when they come into the office. It’s ongoing assistance in helping them manage their disease.”

Diabetes educators come from many different professional backgrounds, including registered nurses, advance practice nurses, physician assistants, nurse practitioners, dietitians, pharmacists, and exercise physiologists.

“Diabetes educators are employed at diabetes education programs within hospitals, physician group practices, and some of these professionals operate independently. We are seeing more pharmacy-based education programs, and even some retail-based programs, such as in Safeway supermarkets,” said Macfarlane.

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Saving Healthcare Dollars

The AADE meeting featured a discussion by Jonathan Oberlander, Ph.D., a professor of social medicine and health policy and management at the University of North Carolina, Chapel Hill, on the impact of the Affordable Care Act (ACA). One of the goals of the ACA, also called Obamacare, is to keep healthcare costs down by giving patients better primary care in order to keep them out of the hospital.

“Healthcare reform is really changing how primary and chronic care is delivered," Macfarlane said. "Our members are perfectly positioned to be a resource to assist in managing what is likely going to be an overtaxed primary care system. The opportunity is for them to be assisting in reducing costs. The association has worked on, and will continue to work on, looking at patient outcomes from a clinical point of view and on their economic impact.”

Data show that diabetes educators help reduce the length of patient hospital stays and, especially, hospital re-admissions, Macfarlane said. “To be able to reduce patients’ [blood sugar levels], which also reduces complications and comorbidities, such as heart disease and hypertension, ultimately impacts costs,” he said.

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Lowering Blood Sugar, Blood Pressure, & Cholesterol

A new study presented at the AADE meeting by researchers from New York-Presbyterian Hospital showed that diabetes education does indeed improve outcomes for people with diabetes, leading to reduced blood sugar, blood pressure, and cholesterol levels.

In the study, 1,263 people with diabetes living in a low-income urban area received four 30-minute, one-on-one sessions with diabetes educators to learn about and work on the AADE7 Self-Care Behaviors. They also participated in group sessions with diabetes educators to help them focus on their choice of one or more of those behaviors.

"Diabetes educator is a growing specialty that allows professionals to engage with their patients in a slightly different way. It’s not a one-time interaction when they come into the office. It’s ongoing assistance in helping them manage their disease.” — Charles Macfarlane

After 15 months of working with a diabetes educator, participants on average lowered their A1C (blood sugar) levels by 67 percent and their LDL (bad) cholesterol levels by 53 percent. After receiving diabetes education, 25 percent of patients had high blood pressure, compared to 32 percent before the study. 

Lovelyamma Varghese, R.N., director of nursing practice and quality for the Ambulatory Care Network at New York-Presbyterian Hospital, said in a press statement, “Diabetes education is not only helpful, it’s necessary for people with the condition. It’s designed to empower patients to self-manage and reach their goals.”

Macfarlane added, “Our goal is to make the public aware that diabetes educators exist. They are out there as a resource to patients and to providers. We view them as a real opportunity to help reduce costs, which is certainly a driver of healthcare reform, but also to provide better patient outcomes.”

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