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The Evolving Role of the Diabetes Educator—Changing Patient Behavior in Diabetes Self-management Education

Published Online: June 6th 2011 US Endocrinology, 2008;4(1):29-31 DOI: http://doi.org/10.17925/USE.2008.04.01.29
Authors: Daniel J Blackman
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In this day and age of evidence-based practice, we seek to provide interventions that we know will make a significant difference in the lives of our patients. For those of us who specialize in the care of people with diabetes, e.g. endocrinologists and diabetes educators, diabetes self-management education/training (DSME/T) has long been considered an essential intervention, a cornerstone of diabetes care. The government’s Healthy People 2010 objective that 60% of persons with diabetes should receive formal diabetes education supports this logic.1 However, for many healthcare professionals outside of the specialty, this belief in the efficacy of DSME/T appears to be less solid, as evidenced by the poor referral rates for education. This disconnect is illustrated by the following findings. Although Medicare covers DSME/T as a benefit for patients with diabetes, only 1% of Medicare beneficiaries received this service in 2004 and 2005.2 The Centers for Disease Control and Prevention (CDC) d ta indicate that only 54.3% of people who responded to a survey had ever attended some type of diabetes self-management class.3 A 2007 Roper US Diabetes Patient Market Study found that only 26% of nearly 17 million diagnosed diabetes patients in the US had visited a diabetes educator within the past year.4 Anecdotal reports from diabetes educators support the notion that with the current type 2 diabetes epidemic facing the US, education programs should be over-run with referrals for DSME/T. This, however, is far from the case for most programs. Most diabetes educators are sorely underutilized, and the rate of recognized diabetes education program closures is staggering, at three per week in the US.5

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As a practicing diabetes educator for the past 15 years, the author has learned that there are a variety of reasons why DSME/T is not a universal intervention for those with diabetes. Many providers do not realize that education services are now reimbursed by Medicare and many health plans. Often, providers are not aware of the diabetes education resources within their own community. Some reserve a referral to education for those patients for whom nothing else has worked to control their diabetes (the proverbial ‘train wrecks’).

As a practicing diabetes educator for the past 15 years, the author has learned that there are a variety of reasons why DSME/T is not a universal intervention for those with diabetes. Many providers do not realize that education services are now reimbursed by Medicare and many health plans. Often, providers are not aware of the diabetes education resources within their own community. Some reserve a referral to education for those patients for whom nothing else has worked to control their diabetes (the proverbial ‘train wrecks’). Other providers operate under the cynical belief that patients are not likely to change their behaviors to improve their diabetes control, even if they do receive education. This article seeks to expound on the relationship between DSME/T and behavior changes, and how the outcomes of diabetes education can be systematically measured to demonstrate its effectiveness in the treatment of individual patients. A review of the literature shows that diabetes education has merit. A metaanalys s by Norris of 72 studies performed over nearly 20 years showed that diabetes education is an effective intervention for patients with type 2 diabetes but that its benefits are short-lived (about six months).6 This reinforces the idea that DSME/T should not be a one-time event, as people need reinforcement of learned behaviors in order to sustain them over time. More research is needed to look into interventions that sustain behavior change.

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