Why You Need (And How to Find) Diabetes Education Courses
Your guide to gaining the know-how, skills, and support to live well with diabetes
Becky Blanton could count on two fingers what she knew about diabetes in the days and weeks that followed her type 2 diagnosis: “I couldn’t have sugar, and I had to take insulin every day,” says Blanton, 61. She was only half right. “I took the initial information provided by the diabetes educator, but I didn’t take it seriously,” she says. “Since there were no symptoms, I just ignored it.”
Fast-forward a year and a half to 2014. Late one night, she suddenly felt nauseous, lightheaded, and inexplicably angry. She shared her symptoms on Facebook, where her friends include other people with diabetes, as well as nurses and paramedics. “About 10 minutes later, I hear a knock at the door, and it’s [emergency medical services], insisting I go with them to the emergency room,” says Blanton, who lives in rural Virginia. She had dismissed the concerns of a Facebook friend who suggested she go to a hospital; he called the emergency response team.
Blanton, as it turned out, was diagnosed with diabetic ketoacidosis (DKA). This life-threatening condition happens when extreme high blood glucose, along with a severe lack of insulin, results in the breakdown of body fat that’s used for energy, causing a buildup of acids, called ketones, in the bloodstream. Though it’s more common in people with type 1 diabetes, DKA can occur in people with type 2 as well. It’s usually triggered by illness, infection, or missed doses of medicines—all of which can lead to high blood glucose. Blanton blames the flu, a sugar binge, and skipped doses of her meds. (She was struggling to pay for insulin, so she took it only sporadically, and because she couldn’t tolerate metformin, she says she quit filling her prescription.)
“The doctor said, ‘If you’d waited until morning, you’d probably be dead,’ ” she says.
Before leaving the hospital, she talked with the same diabetes educator she’d met with in 2013 and, together, they mapped out a plan for how Blanton would learn to manage her disease on a daily basis—a process known as diabetes self-management education and support (or “diabetes education,” for short).
“With some chronic conditions, you take a pill and you’re off and about,” says Maggie Powers, PhD, RD, CDE, a research scientist for the International Diabetes Center at Park Nicollet in Minneapolis and 2016 president of health care and education for the American Diabetes Association (ADA). “But diabetes is a unique condition that requires you to make decisions throughout the day related to food, activity, [and medications]. Education provides the tools and support to help individualize what you need to do on a daily basis.”
As the name suggests, diabetes self-management education and support is the process of giving people with diabetes—and, often, their family and friends—the tools they need for diabetes self-care. According to the American Association of Diabetes Educators (AADE), quality education—whether it’s provided in one-on-one sessions with a diabetes educator, or as part of a program with multiple sessions and instructors—focuses on seven key areas. They involve healthy eating, physical activity, blood glucose monitoring, taking medication as directed, problem solving, risk reduction, and coping. At least one of the instructors leading the sessions should be a health professional—either a certified diabetes educator, a registered nurse, a dietitian, or a pharmacist with training and experience in diabetes education. (See “Two Questions for Your Diabetes Educator,” below.)
In Need of Know-How
The ADA recommends that people with diabetes go for diabetes education when they’re diagnosed and again at three other critical times (see “Continuing Ed,” below). Yet research suggests the overwhelming majority don’t. Although the service is covered by Medicare, just 5 percent of people with newly diagnosed diabetes who are eligible take advantage of it, according to a study published in a 2015 issue of Health Education & Behavior. Of those with private insurance, only about 7 percent opt for it in the first year after diagnosis, says a 2014 study in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.
Confusion about insurance coverage and the need for a referral are among the reasons few people seek out diabetes education, says Jo Ellen Condon, RD, CDE, managing director of the ADA’s Education Recognition Program. Medicare currently covers 10 hours of diabetes self-management education and support in the first year of your initial referral, and two hours a year after that. Private health insurance policies in most states are required to provide some form of coverage for diabetes education, according to the CDC. “It varies from insurance to insurance and from plan to plan, [so] you should check with your insurance company,” suggests Condon.
For Medicare reimbursement, only the provider managing your diabetes—your primary care doctor or endocrinologist, for instance—is allowed to write a referral. So when people in the emergency room with dangerous blood glucose levels are told to see a certified diabetes educator for help with managing the condition, they first have to make an appointment with a doctor who can provide a referral, says Condon.
The ADA is currently advocating to eliminate these barriers by extending the initial 10 hours of diabetes self-management education and support beyond 12 months and by easing restrictions on which health care providers are allowed to prescribe the service.
But these aren’t the only barriers the ADA is advocating to remove, notes Condon. Lack of access, certain beliefs (some people, for example, think they can learn the ins and outs of diabetes management on their own), and confusion over when you need diabetes education and how to find a program can also play a role. That’s why the ADA, along with the AADE and the Academy of Nutrition and Dietetics, joined forces on a position statement in 2015 to clarify the need for education. The goal: “Set clear expectations as to when diabetes education is needed and what the benefits are,” says Powers, lead author of the statement, which was published in The Diabetes Educator, Diabetes Care, and the Journal of the Academy of Nutrition and Dietetics. Those benefits, research shows, include better A1C levels, a lower risk for diabetes-related complications, and lower health-care costs.
Melissa White, who was diagnosed with type 1 diabetes as a child, had diabetes education at a few predictable points in her life, such as when she began using a continuous glucose monitor in addition to a pump. But in the years since her kids, now 12 and 14, were born, the mother of two “was feeling out of control—eating too much junk, not exercising, and not having the readings I wanted,” says White, 46. “I needed to refocus and reprioritize the role of diabetes in my life.”
So she signed up for a weeklong refresher course in diabetes education at the Joslin Diabetes Center in Boston, not far from her home in Arlington, Massachusetts. The program included presentations on nutrition, glucose monitoring, and foot health, as well as daily exercise sessions. “Diabetes isn’t the kind of disease you can have without knowing how to manage it—and the information changes constantly,” she says. “If you’re thinking things are still the way they were even five years ago, you’re missing every opportunity to be okay.”
In the three years since her DKA scare, Becky Blanton has come to value diabetes education. “I realized the only way to … get the best care I could was to learn and keep learning,” says Blanton. “You take the disease more seriously when you understand the results, the progress, and the symptoms.”
Two Questions for Your Diabetes Educator
In the name of making diabetes education easy to attend, sessions are held in a variety of places: doctors’ offices, hospitals, community centers, grocery stores, pharmacies, and even online. Get answers to these questions to make sure you’re getting quality care:
1. What are your credentials?
Look for a diabetes self-management education and support program as identified by the American Diabetes Association or the American Association of Diabetes Educators. That way you’ll know it meets all 10 quality standards for diabetes education. To be eligible for reimbursement by Medicare—and, depending on your plan, private insurance—the program must be recognized or accredited by one of these two organizations. Both have online tools that make it possible to search for a program by ZIP code. For individual providers, look for the credentials CDE (certified diabetes educator) or BC-ADM (board certified in advanced diabetes management).
2. What’s your experience working with people who have diabetes?
The registered dietitian leading the grocery store tour may not be a certified diabetes educator, but she can teach you how to read a food label. What’s important to know: Is she well versed on the nutritional needs of people with diabetes? “If there are no accredited or recognized programs in your community, ask the person leading the program, ‘Are you a licensed health care professional, such as a nurse, pharmacist, or dietitian? What training in diabetes have you had in the last year? Who do you turn to when you don’t know the answer?’ ” suggests Melinda Maryniuk, RD, CDE, director of care programs, Joslin Innovation, at the Joslin Diabetes Center.
Diabetes education isn’t a one-time cram session. “The misunderstanding is that you go once and you’re done,” says Melinda Maryniuk, RD, CDE, director of care programs, Joslin Innovation, at the Joslin Diabetes Center. “But diabetes is always changing—the information changes, the medicines change, and you change, whether it’s because you’re facing new challenges or your medical history is changing.” That’s why the American Diabetes Association and the American Association of Diabetes Educators recommend diabetes education at these four times:
1. At Diagnosis
Your educator will focus with you on establishing your eating plan, creating short- and long-term goals for physical activity, monitoring your blood glucose, taking medications, reducing existing risks, such as smoking, and understanding your numbers.
2. At Least Yearly
Once a year, you and your doctor should assess whether additional diabetes education is in order. You may need it if you’re starting a new medication, you’re experiencing unexplained low or high blood glucose levels, or you aren’t meeting your goals.
3. When Life Is Complicated
Experiencing changes in your overall health, struggling with relationship issues, or dealing with quality of life challenges such as paying your bills? A refresher session can help you balance diabetes and lifestyle changes.
4. For Transitions in Life or in Care
Maybe you’re returning home after being hospitalized. Or maybe you’ve switched insurance plans, and the change is affecting your treatment options. Or perhaps you’ve moved. For anything that affects your care, diabetes education can help.