EditorialPublication Exclusive

Diabetes educators empower, guide patients in self-care, freeing physicians for medical management

Among the strategies identified by the Affordable Care Act to improve health care are the promotion of care coordination and enhanced management of chronic conditions, which are responsible for more than 75% of the nation’s health care spending.

Diabetes is among the most widespread and costly of chronic conditions, affecting 29 million people and costing $245 billion a year. While diabetes can be managed, a key component is self-care. Physicians are faced with the challenging and time-consuming job of helping their patients with diabetes understand the condition, learn how to manage it and then commit to doing so. Further, the influx of patients receiving health care due to the ACA is adding an extra burden to a system already struggling to cope with shortages of primary health care providers and certain specialists, including endocrinologists. Diabetes educators are highly experienced professionals with unique skills who help patients develop strategies to modify their behaviors and successfully self-manage diabetes and its related conditions. Team involvement and patient-focused care has proved to be an efficient and effective model for the management of diabetes.

Joan K. Bardsley

Joan K. Bardsley

Synergistic care coordination

By providing diabetes self-management training (DSMT), diabetes educators fill a key role in the synergistic care coordination model envisioned by the ACA, enabling physicians to focus on the medical management of patients. Communication between all team members is crucial. Diabetes education is not about lecturing. It’s about helping patients discover real-world solutions that fit into their lifestyles and develop self-management techniques that work for them, leading to better metabolic control, improved lipid levels and reduced blood pressure. It also helps physicians increase the efficiency of their practices, as well as meet pay-for-performance and quality improvement goals.

Diabetes education is covered by Medicare and most health plans and is a priority of the US Department of Health and Human Services’ Healthy People 2020. Diabetes education not only makes good common sense, but also it’s backed by research. Studies show people who receive diabetes education are more likely to: use primary care and preventive services; take medications as prescribed; control their glucose, BP and LDL cholesterol; and have lower health costs.

Key self-care behaviors

Diabetes educators teach, guide, motivate and coach people with diabetes so they understand what the condition is, what causes it and the risks of not managing it properly. They take a comprehensive approach to helping patients manage their condition by focusing on seven key self-care behaviors:

Healthy eating: Diabetes educators help people with diabetes understand that what and how often they eat affects their glucose levels. They discuss how to read labels, count carbohydrates and make choices that work for the individual’s likes, schedule and lifestyle.

Being active: Explaining exactly why it’s important to be active and how it is beneficial — from lowering glucose to easing stress — diabetes educators also provide insights regarding how to become more active every day.

Monitoring: Demonstration often is more effective than verbal explanation, so diabetes educators show each patient exactly how to monitor and record glucose levels — including how to use meters and other equipment — and most importantly, what to do when numbers are out of the individual’s goal range. They explain when to monitor and record, as well as the best ways to use monitoring devices and pumps, including assessing equipment choice, timing and frequency of testing.

Taking medication: Through discussions of how medications work, diabetes educators help people understand why it’s important to know and follow the dosage and instructions. They emphasize it’s important to let the doctor or diabetes educator know of any side effects, over-the-counter medications being taken or other concerns.

Problem-solving: Planning ahead is key, and they describe how to plan ahead to avoid problems with glucose levels — such as by bringing snacks and taking medication correctly — as well as teach how to problem-solve when unexpected issues arise or illness strikes.

Healthy coping: Life often is stressful, so it’s important to know how to cope — and even more so for people with diabetes. Therefore, diabetes educators work closely with people with diabetes to discover healthy ways to cope with a variety of problems, from divorce to financial problems to the stress of managing diabetes in general. Diabetes educators identify methods that work for each patient, such as faith-based activities and exercise to hobbies and meditation.

Reducing risks: Reducing health risks can make diabetes management less complicated. Therefore, diabetes educators explain why it’s important not to smoke, as well as to see an eye doctor once a year. They also discuss the importance of working closely with the doctor and diabetes educator to avoid complications through medical management, such as by lowering cholesterol.

Diabetes educators are health care professionals who hail from a variety of backgrounds and include registered nurses and advanced practice nurses, registered dietitians, pharmacists, physical therapists and exercise physiologists, among others. Many diabetes educators work within a program that has been accredited by either the American Association of Diabetes Educators or the American Diabetes Association.

Boren S. The Diabetes Educator. 2008;35:72-96.
CDC. Chronic Disease Prevention and Health Promotion. Available at: www.cdc.gov/chronicdisease/resources/publications/aag/chronic.htm. Accessed May 22, 2014.
CDC. National Diabetes Statistics Report, 2014. Available at: www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed June 13, 2014.
Duncan I. Diabetes Educ. 2009;35:752-760.
Duncan I. Diabetes Educ. 2011;37:638-657.
Morrison F. Diabetes Care. 2012;35:334-341.
Joan K. Bardsley, MBA, RN, CDE, FAADE, is the Assistant Vice President, Scientific Affairs Division, for MedStar Health Research Institute and can be reached at 6526 Belcrest Road, Suite 700, Hyattsville, MD 20782. Physicians interested in finding out more about diabetes educators and programs in their area should visit www.diabeteseducator.org.

Among the strategies identified by the Affordable Care Act to improve health care are the promotion of care coordination and enhanced management of chronic conditions, which are responsible for more than 75% of the nation’s health care spending.

Diabetes is among the most widespread and costly of chronic conditions, affecting 29 million people and costing $245 billion a year. While diabetes can be managed, a key component is self-care. Physicians are faced with the challenging and time-consuming job of helping their patients with diabetes understand the condition, learn how to manage it and then commit to doing so. Further, the influx of patients receiving health care due to the ACA is adding an extra burden to a system already struggling to cope with shortages of primary health care providers and certain specialists, including endocrinologists. Diabetes educators are highly experienced professionals with unique skills who help patients develop strategies to modify their behaviors and successfully self-manage diabetes and its related conditions. Team involvement and patient-focused care has proved to be an efficient and effective model for the management of diabetes.

Joan K. Bardsley

Joan K. Bardsley

Synergistic care coordination

By providing diabetes self-management training (DSMT), diabetes educators fill a key role in the synergistic care coordination model envisioned by the ACA, enabling physicians to focus on the medical management of patients. Communication between all team members is crucial. Diabetes education is not about lecturing. It’s about helping patients discover real-world solutions that fit into their lifestyles and develop self-management techniques that work for them, leading to better metabolic control, improved lipid levels and reduced blood pressure. It also helps physicians increase the efficiency of their practices, as well as meet pay-for-performance and quality improvement goals.

Diabetes education is covered by Medicare and most health plans and is a priority of the US Department of Health and Human Services’ Healthy People 2020. Diabetes education not only makes good common sense, but also it’s backed by research. Studies show people who receive diabetes education are more likely to: use primary care and preventive services; take medications as prescribed; control their glucose, BP and LDL cholesterol; and have lower health costs.

Key self-care behaviors

Diabetes educators teach, guide, motivate and coach people with diabetes so they understand what the condition is, what causes it and the risks of not managing it properly. They take a comprehensive approach to helping patients manage their condition by focusing on seven key self-care behaviors:

Healthy eating: Diabetes educators help people with diabetes understand that what and how often they eat affects their glucose levels. They discuss how to read labels, count carbohydrates and make choices that work for the individual’s likes, schedule and lifestyle.

Being active: Explaining exactly why it’s important to be active and how it is beneficial — from lowering glucose to easing stress — diabetes educators also provide insights regarding how to become more active every day.

Monitoring: Demonstration often is more effective than verbal explanation, so diabetes educators show each patient exactly how to monitor and record glucose levels — including how to use meters and other equipment — and most importantly, what to do when numbers are out of the individual’s goal range. They explain when to monitor and record, as well as the best ways to use monitoring devices and pumps, including assessing equipment choice, timing and frequency of testing.

Taking medication: Through discussions of how medications work, diabetes educators help people understand why it’s important to know and follow the dosage and instructions. They emphasize it’s important to let the doctor or diabetes educator know of any side effects, over-the-counter medications being taken or other concerns.

Problem-solving: Planning ahead is key, and they describe how to plan ahead to avoid problems with glucose levels — such as by bringing snacks and taking medication correctly — as well as teach how to problem-solve when unexpected issues arise or illness strikes.

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Healthy coping: Life often is stressful, so it’s important to know how to cope — and even more so for people with diabetes. Therefore, diabetes educators work closely with people with diabetes to discover healthy ways to cope with a variety of problems, from divorce to financial problems to the stress of managing diabetes in general. Diabetes educators identify methods that work for each patient, such as faith-based activities and exercise to hobbies and meditation.

Reducing risks: Reducing health risks can make diabetes management less complicated. Therefore, diabetes educators explain why it’s important not to smoke, as well as to see an eye doctor once a year. They also discuss the importance of working closely with the doctor and diabetes educator to avoid complications through medical management, such as by lowering cholesterol.

Diabetes educators are health care professionals who hail from a variety of backgrounds and include registered nurses and advanced practice nurses, registered dietitians, pharmacists, physical therapists and exercise physiologists, among others. Many diabetes educators work within a program that has been accredited by either the American Association of Diabetes Educators or the American Diabetes Association.

Boren S. The Diabetes Educator. 2008;35:72-96.
CDC. Chronic Disease Prevention and Health Promotion. Available at: www.cdc.gov/chronicdisease/resources/publications/aag/chronic.htm. Accessed May 22, 2014.
CDC. National Diabetes Statistics Report, 2014. Available at: www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed June 13, 2014.
Duncan I. Diabetes Educ. 2009;35:752-760.
Duncan I. Diabetes Educ. 2011;37:638-657.
Morrison F. Diabetes Care. 2012;35:334-341.
Joan K. Bardsley, MBA, RN, CDE, FAADE, is the Assistant Vice President, Scientific Affairs Division, for MedStar Health Research Institute and can be reached at 6526 Belcrest Road, Suite 700, Hyattsville, MD 20782. Physicians interested in finding out more about diabetes educators and programs in their area should visit www.diabeteseducator.org.