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Broader education efforts needed to improve diabetes self-care
SAN FRANCISCO — Collaborative efforts between health care providers and advocacy groups to improve diabetes self-care were key points emphasized at the presidential address during the American Diabetes Association’s 74th Scientific Sessions.
“We know that there is a shortage of primary care physicians and endocrinologists. We need to work as a health care team in order to increase productivity,” Marjorie Cypress, PhD, C-ANP, CDE, the 2014 president of health care and education of the ADA, from the ABQ Health Partners and an independent consultant, told attendees. “We need to expand the scope of other health care professionals like certified diabetes educators, nurse practitioners, PAs, pharmacists, and behaviorists. Others can monitor patients, adjust some medications, educate and counsel patients.”
Implications of education
Cypress cited a 2014 report by the Institute of Medicine report on health literacy and numeracy, prepared prior to the passage of the Affordable Care Act.
“Only 8.6% of the uninsured adults were proficient in numeracy issues, with 29% below basic levels. People with diabetes and limited health literacy have been shown to have problems acquiring the appropriate knowledge and skills necessary for diabetes self-management and education,” Cypress said.
She added that numeracy skills are needed to select a health plan, choose treatment options, and understand medication instructions.
“These are the adults coming into our health care system now; seeing us for diabetes care and care of other chronic and acute problems,” she said.
Ninety-one percent of the previously uninsured people with diabetes, had difficulty understanding glucose meter readings, interpreting sliding scales, titrating medications and adjusting insulin for carbohydrate content, according to Cypress.
“If we do not address this, we will fail in our efforts to help people with diabetes,” Cypress said.
“We need to create a sense of urgency about the epidemic of diabetes,” she told Endocrine Today.
Behavioral strategies for self-care
Recipient of the Outstanding Educator in Diabetes Award, Katie Weinger, EdD, RN, FAADE, spoke of the complications and implications of diabetes self-care from onset to comorbid phases of the disease in her lecture immediately following Cypress’ presentation.
Weinger, the director of the Center of Innovation in Diabetes Education at the Joslin Diabetes Center in Boston and an associate professor in psychiatry at Harvard Medical School, said that diabetes education requires a collaboration of health care providers and family members of patients.
In a recent study, Weinger and colleagues developed cognitive behavior strategies in diabetes education with the overall goal of improving glycemia.
They randomly assigned 222 patients to one of three education arms: breaking down barriers (n=74), where patients were introduced to cognitive behavioral therapy (CBT) strategies any time they used self-blame; a control group education (n=74), where patients received the same educational content using standard strategies. Both groups had five, 2-hour sessions, the same amount of homework, and exposure to educators, according to Weinger.
The control group (n=74) received individual appointments as many times as they requested over the course of 6 months.
According to Weinger, 50% of patients had type 1 diabetes. Patients with poor glycemic control had a mean HbA1c of 9%, with an average age of 53 years. The mean duration of diabetes was more than 18 years, and all patients were well-educated, she said. They examined the impact of structured education of all patients by group, then by type of diabetes.
Patients with type 2 diabetes responded best to diabetes with the breaking down barriers arm with a one percentage point improvement.
“We found that education did not impact BMI and all arms were similar for disease distress,” she said.
The number of blood glucose checks and reported frequency of self-care improved for all groups.
“Individualizing education approaches is extremely important. One size does not fit all. We have to consider type of diabetes and the phase of diabetes that each person is in. We have to look at individual characteristics, organization, planning and other patient characteristics like depressive symptoms. Patient-provider communication is a key component of supporting people in their efforts to manage diabetes.” – by Samantha Costa
Disclosure: The researchers report no relevant financial disclosures.
For more information:
Cypress M. HCE-01. President, Health Care & Education Address; Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
Weinger K. HCE-01. Outstanding Educator in Diabetes Award Lecture. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
Perspective
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Raising the bar for self-care management is incredibly important. Despite the fact that as diabetes educators, we’re promoting it, we’re trying to educate our patients, most patients are not achieving the targets we have set.
This presidential address really hit the nail on the head in terms of looking to all of us to take a broader look at not just the individual patient, but in terms of what we need to do as a society to help patients get there in terms of looking at making things more health and numeracy literate and providing information to those patients who have the fewest resources.
There aren’t enough diabetes educators; we know we don’t have nearly enough diabetes educators to address the growing need of the increasing number of people living with diabetes.