National Standards for DSME and DSMS – Part 1

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Part 1 of 6 Parts
When I first started reading this, mythought was to bypass it and maybe consider this later, if at all. Something made me come back and read some parts, and ouch! I mustsay my wife was surprised and asked me what was making me roar withlaughter. In reality, this is not funny, but the content and some ofthe ways they approach different parts do make me wonder.
It starts with the first paragraph. Isee these numbers in most sources and can believe that they arerealistic as estimates. The algorithms used probably make thesenumbers more accurate than we realize. Now is where the amusementstarts.  The American Association of DiabetesEducators website formerly had listed memberships of about 13,000members. They have now removed this number for whatever reason and asearch of the site does not reveal the membership numbers.
With 18,800,000people with diabetes and 13,000 CDEs (certified diabetes educators),this means that allotting one hour per patient would mean seeing1,446 different patients per year and having 594 patients they couldsee twice a year. This is figured on a 2,040 hour work year andallowing 80 hours for vacation or two weeks. Now we know thesenumbers are not realistic as many patients are seen four times peryear, or more. We don't know how many CDEs only work part-time, howmany are not doing actual educator work, how many are retired, howmany are in administration, and other numbers writing books and goingon speaking tours. We know that most people with type 2 diabetesnever even see a CDE, therefore we have to question if the CDEmembership numbers are realistic. This says nothing about manyrural areas of the USA where no CDEs live.
I did not include the seven millionpeople that are estimated with undiagnosed diabetes because the CDEswould not be seeing them. Nor will I include any of the estimated 79million people said to have elevated risk of type 2 diabetes. Thenfor the people on the “Task Force” for developing the standardsto make this statement, “Diabetesself-management education (DSME) is a critical element of care forall peoplewith diabetes and those atrisk for developing thedisease,” (bold is my emphasis) really makes me laugh asmany CDEs do not even teach DSME. They seem to prefer mandates andmantras to doing an actual assessment and developing an educationplan based on any assessment.
Until the AADE starts a division forpeer-to-peer workers and peer mentors and gives them some of theskills needed, there will not be sufficient people to use DSME orgive DSMS (diabetes self-management support) to the people with type2 diabetes, much less those at risk for developing the disease. Thestandards have high ideals, but not the personnel to make them work. This is why I needed to laugh to avoid becoming angry.
When I read statements like this blog,and I have to agree with the sentiments expressed, and then alongcomes a comment like the first comment, it really points out theproblems existing in our healthcare system. It also points out theproblems in the CDE profession and their attitude about people withtype 2 diabetes. I am not denying that people with type 1 diabetesmay need more education and support than many people with type 2diabetes. For people to say that endocrinologists should beexclusively for people with type 1 diabetes is not realistic. Morepeople with type 2 diabetes are finding out that insulin works forthem and has less side effects than many of the oral medications. They also need the education and support.
If you are concerned about peer-to-peerworkers, peer mentors, and think I am pushing my own agenda, readthis by the Standards Task Force.
“In thecourse of its work on the Standards, the Task Force identified areasin which there is currently an insufficient amount of research. Inparticular, there are three areas in which the Task Force recommendsadditional research: 1. What is the influence of organizationalstructure on the effectiveness of the provision of DSME and DSMS?2. What is the impact of using a structuredcurriculum in DSME?3. What training should be required forthose community, lay, or peer workers without training in health ordiabetes who are to participate in the provision of DSME and toprovide DSMS?”
Yes, this is one of my aims and I amhappy to see the Task Force suggesting that it be researched. Whileit is being researched, it needs to be acted on now as the number ofpeople developing diabetes will continue to grow and the numbers ofCDEs is not growing at a pace to keep up.
As for research on the influence oforganizational structure on the effectiveness of the provision ofDSME and DSMS, all we need to do is look at what has happened withDSME in the past. The organizational structure may be there at theupper levels, but at the practicing levels, there is no support forit except from rare individuals. There is also little research andsupport for DSME for the elderly as many CDEs will not work with themand consider this a waste of time since these people are no longercontributors to society. I have written about this here and here. It will remain to be seen if they will consider the value many ofthese elderly people could contribute as peer workers. Just don'thold your breath waiting for this to happen.
I would urge everyone to take the timeto read the National Standards to be able to understand what may bepossible. I would also encourage this so that if allowed, we areready for an intelligent dialog and if denied this, as a way to holdthe feet of the CDEs (including the AADE) to the fire. This may beonly one of the ways we can break the exclusionary lock theypresently have and are still very much trying to hold onto by keepinglay people out.