Specialists offer guidance for virtual diabetes education in midst of COVID-19
The COVID-19 pandemic has prompted an unprecedented and rapid transition to virtual or telehealth services for many clinicians and health care providers, including diabetes care and education specialists, who are working to quickly shift patients to a new format and adapt classes to meet changing priorities.
In a post published March 18 on the Association of Diabetes Care & Education Specialists’ blog “Perspectives on Diabetes Care,” Angela Forfia, MA, senior manager of prevention for ADCES, wrote that many diabetes prevention organizations are wondering how to best sustain their CDC-recognized lifestyle change programs in the midst of the continued impact of COVID-19, and certified diabetes care and education specialists have been reaching out with questions.
“We are all discovering, in real time, how best to do this,” Forfia told Healio. “The first question we are hearing — and the first question a diabetes care and education specialist should ask himself or herself — is where are we in the Diabetes Prevention Program? If you just did a ‘session 0’ and you were planning to kick this off in the beginning of April, that may be a good time to pause the program. For someone who is 10 months in and has only has a few sessions left, it is very easy to conduct those sessions by conference call or by one-on-one makeup sessions. Where it becomes challenging is when you’re nine or 10 sessions in. At that point, what you choose to do is really a joint decision between the educator and the group members.”
For DPP programs, Forfia said the CDC will not penalize an organization for programming interruptions due to COVID-19. If the organization holds preliminary or full recognition, they keep their status, even if they cannot make a full data submission to CDC, she said. The CDC is also encouraging organizations to use as many online or distance learning make-up sessions as needed, regardless of how a program is typically delivered.
“The thing that I would clarify is ‘virtual,’” Forfia said. “’Virtual’ is what the rest of the world calls ‘online.’ A diabetes care and education specialist can hold their sessions as online sessions, which is virtual, or via ‘distance learning,’ which is by telehealth. When you become a recognized organization with the CDC, you have to state whether you are an in-person, online or distance learning provider — what modality you typically deliver the program in. Now, no matter how you are registered, you can use virtual or distance learning sessions.”
Social distance, changing curriculum
People with diabetes are not at greater risk for contracting COVID-19, the novel coronavirus, but they are at risk for worse outcomes should they become ill, according to experts. That reality means diabetes care and education specialists must shift their focus when providing diabetes education via virtual or distance learning, according to Lisa Ranes, RD, CDCES, CSOWM, a spokesperson for ADCES.
“There are two important points to focus on, and one is sick day management,” Ranes told Healio. “If I do become sick, how do I manage my diabetes safely? The one thing that diabetes care and education specialists can do during this time is help keep our patients with diabetes home and not coming to the hospital. That means really focusing on sick day management and how to have an emergency plan in place. What should you have if you have to stay in place for 2 weeks? How much food, water and medicine do you need?”
The other focus for educators during virtual sessions is mental health, Ranes said.
“People are anxious and stressed, and there may be some depression,” Ranes said. “We need to help our patients with one of our core behaviors of healthy coping. We know that stress, depression and anxiety can increase our blood glucose level, and we must help them to identify ways that help them manage stress, whether it’s journaling or meditation or calling a friend. Maybe we can’t go see a friend in person right now, but we can certainly phone a friend.”
Physical activity is also key during this time, Ranes said, and coaching can be vital for older adults who may be isolated.
“Most gyms are closed, so we must focus on different exercises for our patients,” Ranes said. “They could be setting a timer and walking stairs at home. Get creative on how to be active within the home, and provide coaching on the best apps to stay active if the person has a smartphone or a tablet.”
‘Stay healthy at home’
Forfia said it is important now more than ever to “get creative” with DPP sessions or diabetes self-management education.
“That is the conversation we are having with our diabetes care and education specialists and lifestyle coaches: Navigate this together,” Forfia said. “What is going on in your center? What resources do you have, what are you capable of as a provider, and can you bring your group along for the ride? Allow them to try out this new way of interacting, because they might love it and get everything that they need. A lot of the support comes from others in the group, asking, ‘What is everybody else doing to stay active?’ It’s not about the lifestyle coach necessarily having all of answers, but allowing the group to learn from each other.”
Ranes said the diabetes educator community has risen to meet the challenge of moving to new channels quickly.
“From what I am seeing, we are just embracing this,” Ranes said. “We are experts in this. We can deliver great care virtually and have been wanting this for many years. It’s an easier switch for our discipline. We know we can help people stay healthy at home.”
Ranes said the virtual visits also have another unexpected benefit for patients — a real need to learn how to effectively use diabetes devices.
“What we’re finding in clinic is patients now have to get more engaged in their self-management care,” Ranes said. “When we typically see them face-to-face, we do enable them a bit, uploading their insulin pump or their CGM device. When we come out of this, we may see more engagement.” – by Regina Schaffer
ADCES. The latest guidance for diabetes prevention programs during the COVID-19 pandemic. Available at: https://www.diabeteseducator.org/news/perspectives/aade-blog-details/adces-perspectives-on-diabetes-care/2020/03/18/the-latest-guidance-for-diabetes-prevention-programs-during-the-covid-19-pandemic. Accessed: March 24.
For more information:
Angela Forfia, MA, can be reached at firstname.lastname@example.org.
Lisa Ranes, RD, CDCES, CSOWM, can be reached at email@example.com.
Disclosures: Forfia and Ranes report no relevant financial disclosures.