Conference Coverage

NEWS FROM THE AMERICAN ASSOCIATION OF DIABETES EDUCATORS (AADE)
2009 Annual Meeting & Exhibition Exploring New Dimensions: State-of- the-Art Education for Diabetes Care
August 5–8, 2009 - Atlanta

AADE, Emory, and J&J Diabetes Institute Partner to Educate, Improve Access to Care for Atlanta-Area Minorities With Diabetes
The AADE announced the launch of an Atlanta-based program aimed at improving diabetes self-management among minority populations. In partnership with Emory University's Latino Diabetes Education Program and the Johnson & Johnson Diabetes Institute, the program aims to advance diabetes education in Hispanic and African American populations and to improve clinical and behavioral outcomes, according to an AADE news release. The announcement was made during a news conference at the Association's annual meeting.

The program will be offered in the Chamblee neighborhood, served by the North DeKalb Health Clinic. The clinic belongs to the satellite neighborhood network of clinics of Grady Health System in the Metro Atlanta area. Emory's Latino Diabetes Education Program is already serving the Latino community in this area and will partner with Grady and AADE to implement this minority-specific model.

The goals of the project, Increasing Access to Diabetes Self-Management Education as a Means of Decreasing Health Disparities in Minority Populations, are:

• Ensuring high-quality and culturally appropriate services for people with diabetes by involving different members of the disease management team including physicians, educators, health promoters/community health workers, and other health care professionals.
• Teaching the basics of diabetes self-management to populations often lacking in education and community-focused support.
• Building upon local program capacity to achieve desired clinical and behavioral outcomes.

Individuals from minority communities that participate in this program will receive support and tools that will empower them to improve their health and clinical outcomes, change behaviors, set goals and gain problem solving and healthy coping skills, and learn how to navigate the health care system to increase adherence to evidence-based guidelines and reduce high-cost emergency department utilization.

"This program is unique in that it promotes a team approach to diabetes care. Each member of the team—physician, diabetes educator, and community health worker—supports and builds upon one another's work," said AADE President Marcia Draheim, RN, CDE. "Success will be measured by many factors including clinical improvements, behavioral outcomes, participation, and patient satisfaction with the program."

Emory University School of Medicine and Grady Health System have been serving Latinos with diabetes through the Emory Latino Diabetes Education Program. "The program started more than 3 years ago and has reached more than 750 Latinos with diabetes and their families," said Amparo Gonzalez, RN, CDE, Program Director. "This grant offers the opportunity to apply the successes and experiences that the Emory Latino Diabetes Education has had with Latino community to the African American community."

The program is sponsored through a grant from the Johnson & Johnson Diabetes Institute. The J&J Diabetes Institute is a global initiative that provides health care professionals with access to the latest information and skills training to deliver quality care at the community level, and do so in a care model that facilitates early glucose control and appropriate follow-up. J&J Diabetes Institute aims to be a catalyst for diabetes innovation, improved care, and better outcomes worldwide through educational programs, according to the news release.

Diabetes disproportionately affects minority individuals, who comprise a significant segment of the US population. According to the US Census Bureau, Latinos represent the US' largest minority group making up 14.8% of the population or 43 million people. According to the Centers for Disease Control and Prevention:

• Non-Hispanic whites: 14.9 million, or 9.8% of all non-Hispanic whites aged ³20 years have diabetes.
• Non-Hispanic blacks: 3.7 million, or 14.7% of all non-Hispanic blacks aged ³20 years have diabetes.

Health disparities are increasing in the United States. Individuals in African American and Hispanic neighborhoods, in particular, face many barriers to achieving successful self-management of their diabetes. These barriers are attributable to structural factors (eg, lack of sidewalks or access to food stores with affordable produce) as well as the cultural, socioeconomic, and literacy characteristics of the people living there.

AADE Position Statement: Special Considerations in the Management and Education of Older Individuals With Diabetes
The AADE released a position statement to help guide diabetes educators on how to help older adults with diabetes. The position paper, "Special Considerations in the Management and Education of Older Persons With Diabetes," is available on the AADE Web site, www.diabeteseducator.org.

"We updated our [statement] because the US population is aging and AADE aims to position itself and its membership to recognize and adequately accommodate the unique needs of the elderly population in the future," said Lana Vukovljak, MS, MA, chief executive officer of the AADE.

Ms. Vukovljak said the new position reaffirms the previous AADE statements that diabetes educators are integral to geriatric care. "It will help educators and others understand the important role that educators play in helping older adults with diabetes achieve optimal outcomes," she said.

The new position reflects rapidly changing health care demographics in the United States. According to background information in the statement, by 2030, the number of older Americans will have more than doubled to 70 million. Age-related factors may interfere with self-management of diabetes, as most people aged >70 years will have some deterioration in mental and physical functioning, even if their ability to learn may not be impaired.

The new statement also incorporates recent evidence from the diabetes literature while also addressing the role of the educator with an older population, said Karen Fitzner, PhD, Chief Science and Practice Officer for the AADE. She stressed that the new position also explicitly addresses the AADE7 Self-Care Behaviors as they bear on an older patient population.

AADE Survey Reveals Profile of Diabetes Educators
The average diabetes educator has a median salary of $64,900 per year, has a bachelor's degree, and is 51 years of age, according to the 2008 Salary Survey commissioned by the AADE and released here during the annual meeting. This is the first survey of its kind for the diabetes education profession, according to a news release from AADE.

Diabetes education is a collaborative process through which people with or at risk for diabetes work with a skilled professional to gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions.

"Surveys like this help our members to proactively respond to changes in their profession and practice," said Lana Vukovljak, MS, MA, CEO of the AADE. "The data demonstrate the strong educational and experiential foundation that qualifies educators to meet evidence-based practice standards for excellence in diabetes care. On a basic level, these characteristics assist in understanding who diabetes educators are."

The AADE analyzed survey responses from 5,823 respondents from both AADE member and nonmember lists. Data were collected from October 31 to November 24, 2008. The survey found that 31% of the respondents were aged >51 years and only 9% were aged <35 years. Very few diabetes educators are male—only 3%, according to the survey.

Approximately 88% of respondents hold the certified diabetes educator (CDE) credential, and the average respondent has 25 years of health care experience; 21% have >20 years, and 15% have <5 years.

A majority of diabetes educators are nurses, with 40% describing themselves as registered nurses, 7% percent indicating they were clinical nurse specialists, and 4% nurse practitioners. A significant percentage—37%—said they were registered dietitians.

Diabetes educators most frequently (43%) report they work in a university or hospital setting, and 12% indicated an inpatient hospital setting. Eleven percent reported they work in a doctor's office; 8% work in a health system ambulatory clinic, and 6% in a community-based setting. About three-quarters of diabetes educators work in either urban (41%) or suburban (34%) settings, whereas 22% are found in rural areas and 2% in tribal/Indian Health Service settings.

Ninety-five percent of respondents are responsible for and/or personally perform diabetes self-management education, 57% cite responsibility for health care professional education, and 50% name medical nutrition therapy. Also cited by more than one-quarter are disease management, clinical (medical management), telephone care management, counseling services, and case management. Only one in 10 named research or home care diabetes education as areas of responsibility.

Virtually all respondents (98%) report working directly with patients in diabetes education. The typical professional spends 73% of his/her work time in patient contact, and the median number of patients seen per week is 18, with 9% seeing ³40 and 18% seeing <10. Thirty-two percent of respondents directly supervise other people, and 21% report budget responsibility.

Seventy percent of those responding to the survey said they work full time, and the median base pay was $31.20 per hour—with 2% earning ³$45.00 and 15% earning <$25.00 per hour. The average base pay annualizes to $64,900 per year with 7% reporting ³$100,000 per year and 11% earning <$50,000. Including other cash compensation, the total median compensation is $65,520.

New Recommendations in Self-Monitoring of Blood Glucose
"Self-monitoring of blood glucose (SMBG) will continue be valued, meaning clinically important and reimbursable, only if it is considered part of the priorities of care for diabetes," said Richard Bergenstal, MD during a presentation here. Establishing the evidence base of the essential nature of SMBG and translating that evidence into a practical approach to utilizing SMBG as a management tool should be a professional goal, he added. Dr. Bergenstal is the Executive Director of the International Diabetes Center, Park Nicollet Clinic in Minneapolis, and Chief Medical Editor of Review of Endocrinology.

Every patient with diabetes, at every visit or contact, should receive a treatment plan—that is documented—for optimizing glucose control, according to Dr. Bergenstal. "To achieve this, a new model of diabetes care that engages a team as standard practice is needed," he said. "Diabetes educators are at the center of a new dimension in the effective use of SMBG. That dimension will be realized once every patient interacting with a medical team knows when to test, what their values should be and how to take action to improve SMBG and continuous glucose monitoring values."

Dr. Bergenstal discussed the recently published results from the EDIC (Epidemiology of Diabetes Interventions and Complications) follow-up to DCCT (Diabetes Control and Complications Trial) which found that intensive glucose control halves complications of longstanding type 1 diabetes. EDIC also found that the outlook for people with longstanding type 1 diabetes has greatly improved in the past 20 years due to a better understanding of the importance of intensive glucose control as well as advances in insulin formulations, insulin delivery, glucose monitoring, and the treatment of cardiovascular risk factors.

Patton Medical Partners With Unomedical on i-port Advance
Patton Medical Devices, manufacturer of the i-port and a leader of injection port therapy, announced that they have entered into a partnership agreement with Unomedical, a leading manufacturer of single-use medical devices for the treatment of diabetes.

According to Patton, the companies are working together to design and develop the i-port Advance, the first subcutaneous injection port for people taking multiple daily injections to include a disposable inserter, that will assist patients with the application process and eliminate the need for manual insertion. The i-port Advance, similar in design to the i-port, will also provide improved features that may help to reduce insertion pain and enhance the user experience.

As part of the agreement, Patton has exclusive rights to market and distribute the i-port Advance both in the United States and international markets while Unomedical has exclusive manufacturing rights.

Both companies are working together to have the i-port Advance commercially available in the United States and other countries by April 2010.

Roche Diabetes Care Announces Unique Coaching Program for CDEs
Roche, the maker of Accu-Check blood glucose monitoring systems and insulin pumps, announced the latest component of its Behavior Change Through Patient Engagement program. Creative Coaching is an advanced educational program that fights the growing epidemic of diabetes by improving dialogue between diabetes educators and their patients, according to the company.

"As the world leader in diabetes diagnostics, we truly appreciate the efforts of educators, and other health care professionals, who help their patients lead healthier lifestyles," said Sr. Vice President & General Manager of Roche Diabetes Care North America Luc Vierstraete. "They represent the front lines in the fight against poorly managed diabetes and its devastating effects. These professionals are already so adept at the science of diabetes—this program helps them with the art of patient engagement."

Recent participants in the program say they value not only the foundation of adult learning styles and coaching skills, but also the ability to interact with one another while learning how to effectively integrate Accu-Chek products and tools. When educators return to their practices, they are better prepared to apply best practices and achieve breakthroughs with their patients.

"What I appreciated most was the purpose of the weekend, which was to increase the quality of our health care," said CDE Linda Filipi, BSN, RN, of Laguna Hills, Calif. "For us that means how to become better educators—for [Roche] it is how to offer quality products. The end result is the same: it means that patients live longer, healthier, and happier lives."

Creative Coaching is just one part of the Behavior Change Through Patient Engagement program. Other elements include education to health care professionals on psychological barriers to self-care, direct-to-patient education that helps adults, children, and teens make self-management easier; and simple, paper-based tools that help patients discover how the actions they take every day matter.