Imagine being informed that you have prediabetes, gestational, Type 2 or Type 1 diabetes. A range of thoughts flood the mind. What? How? Are you serious? Not me! Now life takes a new twist. As a diabetes educator who has walked the journey alongside persons with prediabetes, gestational diabetes, Type 2 and Type 1, I have had the gut-wrenching experience of seeing first-hand the anguish, grief and disappointment the diagnosis can bring. Walking the journey after being given one of these diagnoses is certainly not easy yet it does not have to be travelled alone. The health care team, peer support community, loved ones and friends are valuable resources on the journey. Within the health care team, a diabetes educator is a unique resource for those living with prediabetes, gestational diabetes, Type 2 or Type 1 diabetes. You may be wondering, who is a diabetes educator? What support and services can they provide? When is it appropriate to see an educator?
Who? Diabetes education is considered a specialty with the diabetes educator having a primary health discipline (i.e. medicine, nursing, pharmacy). A Diabetes educator, from a discipline standpoint, can be a nurse, dietician, physician assistant, nurse practitioner, pharmacist, physician, physical therapist, social worker, clinical psychologist, exercise physiologist, health educator, occupational therapist, optometrist, podiatrist, and additional disciplines – what a variety! Diabetes educators can become Certified Diabetes Educators (CDE) through National Certification Board for Diabetes Educators (NCBDE).
What? Unfortunately, some folks imagine someone reading off a list of dos and don’ts with a handout thrown in when they consider the “what” of diabetes educator services. Wow, it is SO much more. Rather, a diabetes educator can provide a broad spectrum of services for the person living with diabetes and prediabetes and their caregivers. In terms of education, consider someone sitting down with you to discuss your concerns and needs, developing a plan for self-managing your diabetes in collaboration with you, and providing ongoing support in the day to day of living with diabetes and prediabetes addressing the unique needs and concerns at various times. Depending on the educator’s primary discipline, clinical management of diabetes in collaboration with person living with diabetes is also a service. Providing technology support in terms of tools (continuous glucose monitors, insulin pumps, apps, etc.), interpreting data to adjust treatment based on the data and driving innovation with use of technology. Supporting the emotional well-being of the whole person living with diabetes or prediabetes with a focus on behavioral health. Ultimately, the diabetes educator’s day to day activities may look different based on their primary discipline yet all educators are advocates for person centered care and all persons living with diabetes and prediabetes.
When? According to a joint statement from American Diabetes Association, American Association of Diabetes Educators and Academy of Nutrition and Dietetics, the four critical times for diabetes self-management education and support for person with Type 2 diabetes are at diagnosis; annually to assess education, nutrition and emotional needs; when complicating factors influence self-management, and when transitions in care occur. Complicating factors that influence self-management are health conditions (i.e. kidney disease, stroke, heart attack), complicated medication regimen, steroid therapy, limitations such as visual or physical impairments, anxiety, depression, limited access to food and financial limitations. Transitions in care goes beyond discharge from hospital back into community. Also change in medical care team, treatment change due to insurance coverage or age-related changes that impact cognition or ability to care for one’s self.
For persons living with Type 1 diabetes, diabetes educators are often housed within endocrinologist, some primary care offices or hospitals. Within this population, diabetes educators are often collaborating with person with Type 1 diabetes in technology such as insulin pumps in starting and adjusting pump therapy and continuous glucose monitor. Additionally, educators teach survival skills and provide vital ongoing support.
In terms of prediabetes, diabetes educator will work collaboratively with individuals to help facilitate behavior change in nutrition and physical activity to prevent the development of Type 2 diabetes. This collaboration often occurs in a group setting through Diabetes Prevention Programs which is a covered benefit for Medicare and many private insurance plans. The prevention programs are typically a year in length with focused sessions on aspects of behavioral change and vigorous ongoing support. As we all know, behavioral change can be a challenge for ALL of us.
I have provided several links below with more information on critical times for diabetes self-management and support, diabetes certification and diabetes prevention programs.
https://www.diabeteseducator.org/docs/default-source/practice/algorithm-of-care.pdf?sfvrsn=2
https://www.cdc.gov/diabetes/prevention/index.html
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