CADE Newsletter Spring/Summer 2013
Content
Spring/Summer Edition, 2013
Connecticut Alliance of Diabetes Educators Save the Dates: Future Meetings
General meetings – Location- Midstate Medical Center, Meriden Thursday, Sept 12, 2013 at 5:00 pm Speaker sponsored by Janssen Pharmaceuticals on SGLT-2 inhibitors Dinner provided Tuesday, October 22, 2013 at 5:00 pm, Speaker and dinner sponsored by Lilly on Transitioning from oral agents to Insulin Wed, November 6, 2013, All day ADA Diabetes Symposium for Healthcare Professionals At Crowne Plaza in Cromwell, CT
FYI: Board meetings will take place via conference calls
CADE Newsletter
Spring/Summer Edition, 2013
President’s Message
Hello! I hope you are all enjoying your summer, despite the mostly awful weather we have been having! As of July 1, 2013, CADE transitioned into its 2013 – 2014 program year, which will run through June 30, 2014. I am honored to serve as CADE President, and I am really looking forward to a fun and productive year. Membership dues are now being collected and can by paid by check or through PayPal. As of July 1st, 27 members have already taken advantage of the convenience of PayPal to renew their memberships. CADE dues are still just $50/ year, and CADE members receive many benefits, including: • The opportunity to network with over 100 local colleagues who work in the field of diabetes: • 6 meetings a year in a central Connecticut location (Meriden), many with dinner included • Annual Membership Directory distributed electronically in early fall !!Up-to-the minute educational offerings on topics of interest to members! ! Free use of our Resource Library with a variety of current books, DVDs, !Discounts to other diabetes-related activities, such as the Cardiometabolic Health Congress in Boston !Annual scholarship and Educator of the Year awards !! If you haven’t already, I encourage you to please renew your CADE membership today, and to invite a colleague to join us as well! I’m looking forward to seeing you at our first meeting of the year on September 12, 2013 at 5:00 p.m. at Mid-State Medical Center in Meriden. Sincerely, 2 Lisa Gilmore, RN, MSN, MBA, CDE 2
CADE Board of Directors 2013-2014
President Co-Presidents-Elect Treasurer Secretary Past President Members-at-Large Lisa Gilmore, RN, MSN, MBA, CDE Jean Kostak, MS, RD, CD-N, CDE Karen McAvoy, MSN, RN Mary Jo Farrelly, RD, CDE Kari Davis, RN, MSN, BC-FNP, CDE Beth Caffrey, MPH, RD, CDE Amy Sullivan, RN, MPH, CDE Kathy Wietrak, APRN, CDE
Nominating Committee Cindy Kozak, RD, CDE, MPH Sandy Micalizzi, APRN, CDE Committee Chairpersons Bylaws Hospitality Linda Ferro, MSN, APRN, CDE Pam Howard, APRN, CDE Diane Bussolini, RD, CD-N, CDE Lisa Pranger, RD, CDE Kathy Wietrak, APRN, CDE Louise Butcher Jill Ely, MSN, APRN, CDE Barbara Nadolny, RN, BSN, CDE Trish Comrie-Scheer, RD, CD-N, CDE Nancy Held, MS, RD, CDE
Legislative
Membership Newsletter Editor
Professional Education Sangeeta Ahuja, RD, CDE, CD-N Donna Hansen, BSN, RN, CDE Scott Hozebin Public Relations Resource Library Web Master Betsy Guadian, RN-BC, RD, CDE Diane DeMain, RN, MS Leigh Bak, MS, RN, CDE Molly Kirshner, RD, CD-N, CDE 3
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Spring/Summer Edition, 2013
Message from the immediate past-President of CADE
Uncertain … Not known or established It seems fitting that the first two CADE meetings of 2013 addressed topics, which reveal the uncertainty of healthcare in our nation. Both the Affordable Care Act and Managing Inpatient Technology (CSII during Hospitalization) present new challenges and opportunities for providers, educators, and clients. As our first speaker, Thomas Buckley, RPh, MPH, explained, the Affordable Care Act was enacted with the intent of making healthcare more accessible and more affordable for Americans. However, the best way to achieve this goal while providing better care for individuals and better health for populations is yet to be determined. The second topic, Managing Inpatient Technology- a Taskforce Summary of current CSII during hospitalization in CT was moderated by Molly Kirschner, RD, CD-N, CDE, and Nancy Ryan, MS, RD, BC-ADM, CDE, CD-N. This first step involved sharing information regarding the current policies and procedures in CT hospitals for patients that use CSII. The discussion addressed the need for additional training of inpatient staff regarding CSII so that clients are safe in this environment utilizing this technology. Although not knowing exactly what lies ahead for our DSME programs, our inpatient components, our private industry members, and even our clients, CADE offers the opportunity for us to come together and share our findings. It enables members to learn about new initiatives that are successful. This may be an uncertain time for healthcare. But it’s also opportunity to continue to grow and improve. Respectfully Submitted, Beth Caffrey, MPH, RD, CDE, CD-N
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Spring/Summer Edition, 2013
Kudos and Happenings for CADE Members
The 2013 Diabetes Educator of the Year : Sandy Micalizzi, APRN, CDE!!! The following poem was written in honor of Sandy:
It does my pancreas good to inject some new beta cells onto the list of Educators of the Year. In 2013, it was difficult but the choice was very clear. She has spoken of carbohydrates, exercise and meds What must she do to get it in their heads? Assisting her patients and helping her peers Could not even bring our EOY to tears. Speaking to the community or going to health fairs All while maintaining impeccable hair. When teaching a patient the insulin pump You will note that her mascara will not even clump! Pills, insulin, meters, pens, needles and diet If it will improve control she will have her patient try it. Being a local, state and federal activist Has our EOY looking for a good hair colorist. If your patients continue to eat candy don’t get in a tizzy Just call the 2013 Educator of the Year Sandy Micalizzi.
Sandy has been past co-president and active member of CADE, as well a member of various community and professional organizations. Presently she is clinical nurse specialist at the Heart Center of Greater Waterbury and has many clinical and educational experiences. CONGRATULATIONS SANDY! The 2013 $500 Education Scholarship recipient is Maureen Moore, RN, MA, CDE. Currently she volunteers at a free clinic providing diabetes care for about 40 patients that are uninsured or underinsured. She plans to use the scholarship to go to a national meeting. CONGRATULATIONS Maureen!
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5
Spring/Summer Edition, 2013
More Kudos and Happenings for CADE Members
Leigh Bak published an article on Support Group Savvy in the March/April issue of Practical Diabetology. Linda Ferro, APRN, recently started a new job at Soundview Medical Associates in Norwalk. Lisa Gilmore RN, MSN, MBA, CDE was recognized with the Nightingale Excellence in Nursing Award from the William W. Backus Hospital on May 9, 2013 Donna Hansen, BSN, RN, CDE will be on the faculty as a lecturer at Housatonic Community College in Bridgeport. The course will focus on health and wellness and prevention of diabetes. The classes are Adult Ed. The link is: http://www.housatonic.edu/ce/Wellness/ Judy McCarthy and Reninca LaBella who work for Lifescan, a division of the J & J Diabetes Franchise, were recently awarded the “Presidents Circle of Excellence” for their high quality work in Connecticut. Lois Pelletier RN, CDE renewed her CDE this September for the 5th time! Betsy Gaudian is looking for a position is diabetes education. Please email her if you can help [email protected] Charlotte Hungerford Hospital renewed its ADA Recognition in Feb 2013.
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Other Dates to put on your calendars:
Step Out: Walk to Stop Diabetes - one great walk, 4 sites! Savin Rock Boardwalk, West Haven, 9/21/13 Ocean Beach Park, New London, 9/29/13 Bushnell Park, Hartford, 10/5/13 Fairfield County, 10/6/13 – West Hill High School, Stamford, CT Online registration will be available mid-May at www.diabetes.org/stepout; for more information call the ADA office and you will be connected to the appropriate walk coordinator. ADA Endocrinology Seminar – September 19, 2013, Dr. Silvio Inzucchi is the keynote speaker This will be held at the Crowne Plaza Hotel, Cromwell, CT. For more information, contact Louise Butcher, 203-639-0385 AADE National Meeting August 7-10 Cardiometabolic Health Congress October 2-5, Boston, MA ! !!
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7
This group of representatives met with Dept of social services Medical Director Robert Zavoski MD and several other policy makers. The meeting was held on 1/9/13 at Dept of Social Services in Hartford. The purpose was to discuss reimbursement for DSMT by Ct State Medicaid. Each of our group presented a topic to include: Why we here and ADA's interest, The essentials of diabetes care, What is DSMT, What is a CDE, What is a credentialed program, How is it reimbursed by Medicare and Ct state insurance mandate, benefits from physician perspective. The results of the meeting were that from a clinical perspective they understand the benefit. But there are laws that our state Medicaid plan falls under that exclude education from coverage. 35 states have Medicaid coverage so our next step is to explore how other states are covering it. Since the meeting Barbara Nadolny has continued to correspond with the Medical Director and is slowly making headway. Pictured are Stephen Habbe ADA
Advocate, Lois Pelletier RN CDE, Sally Cooney MPH RN CDE, Barbara Nadolny RN CDE, Egils Bogdanovics MD.
Spring/Summer Edition, 2013
Diabetes Self -Management Education 2013 Cindy Kozak, RD, MPH, CDE, CT Dept. of Public Health
Diabetes self-management education (DSME) is the ongoing process of facilitating the knowledge, skills and abilities necessary for diabetes (and prediabetes) self-care. It is a critical element of care for all people with diabetes and is necessary to prevent or delay the complications of diabetes. (1-5) Promoting access to DSME is a core objective of the Connecticut Diabetes Prevention and Control for 2013-18. Currently only 49.5% of adults with diabetes receive self-management education (2008-10 BRFSS) Connecticut data An analysis of Connecticut data showed that people with diabetes are more likely to obtain comprehensive diabetes clinical care (including eye exams, foot exams and influenza vaccinations) if they attend DSME (56.1%) vs. 40.2% for those who never attended DSME. (6) These preventive care practices are known to prevent or delay costly diabetes complications. Diabetes Diagnoses in Emergency Departments (ED) Diabetes is a leading cause of ED Visits in the US. Among US adults, about 6.4% of ED visits or 733,600 visits had diabetes with complications as the first listed diagnosis in 2009. In comparison, 5.4% of ED visits among adults were for non- specific chest pain and 3.5% were for congestive heart failure. (7) However, evidence from the national Agency for Healthcare Quality and Research (AHRQ) suggests that many ED visits with diabetes are preventable. One such study revealed that increased adherence to diabetes medications can reduce the rate of ED visits by over 46%. (8) Medication adherence is a key topic addressed in DSME. According to the American Diabetes Association the prevention of acute complications of diabetes requires continuing medical care as well as ongoing patient self-management education and support. (9) In the Medicaid population results from a study by Balamurugan et. al.“clearly suggest that DSME decreased health care use among Medicaid recipients, particularly hospital admissions and ED visits”. (10)
Spring/Summer Edition, 2013
Hospitalizations Robbins et.al studied educational visits in eight public safety net primary care clinics vis a vis hospitalization rates and charges. Their “most important finding is that both diabetes classes (and nutritionist visits) were strongly associated with reductions in patient hospitalizations and hospital charges”. (11) In an article by Micklethwaite published in Population Health Management in 2012 the author described a DSME intervention that resulted in significant improvement in blood sugar control and saved the hospital an average of $551 per active patient per year, primarily through reducing hospital visits. This study was able to demonstrate that the hospital was able to avoid more costs than it incurred. (12) Hospital Re-Admissions For hospitals striving to maintain cost by decreasing hospital readmissions, DSME can have a positive impact. In a study by Duncan et. al., DSME resulted in a 34% decrease in hospital readmissions. A 5.7% decrease in overall costs per year, and a 12% decrease in costs after 3 years, for those people with diabetes who received diabetes education versus those that did not was also shown. (13) Other cost information Duncan’s work also showed that commercially insured members who participated in DSME cost on average 5.6% less than members who do not access DSME (13). Another article by Duncan concluded people with diabetes who had DSME provided specifically by a credentialed diabetes educator in an accredited/recognized program are likely to show lower cost patterns when compared to a control group of people with diabetes who did not get DSME. People with diabetes who have multiple episodes of DSME are more likely to receive care in accordance with the
recommended guidelines and to comply with diabetes related prescription regimens, resulting in lower cost and utilization trends. (14)
References 1. Brown SA. Interventions to promote diabetes self-management: state of the science. Diab. Educ. 1999; 25 (6) suppl 52-61. 2. Norris, SL et al Self-management education for adults with type 2 diabetes: a meta analysis of the effect on glycemic control. Diabetes Care. 2002: 25 (70; 1159-71. 3. Gary, GL. Et al Meta- analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Educ. 2003; 29 (3) 488-501. 4. Deakin T. et al Group based training for self-management strategies in people with type 2 diabetes. Cochrane Datebase Syst Rev 2005:2: CD003417. 5. Renders, CM et al, Interventions to improve the management of diabetes in primary care, outpatient and community settings: a systematic review. Diabetes Care. 2001: 24 (10)1821-1833. 6. CT DPH data on CT Behavioral Risk Factor Surveillance System, 2008-10. 7. National Emergency Department Samples, Agency for Healthcare Research and Quality. Data computed by personnel in CDC’s Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Available at http://www.cdc.gov/diabetes/statistics/emergency_national.htm) 8. (Encinosa, W. et. al. (2010). Does Prescription Drug Adherence Reduce Hospitalizations and Costs? The case of Diabetes. Advances in Health Economics and Health Services Research, 22, 151-173. (AHRQ 11-R008). 9. American Diabetes Association. (2012) Diabetes Care, 35, (Supplement 1), S11-63. 10. Balamurugan, A. et. al., Diabetes Self- Management Education Program for Medicaid Recipients. The Diabetes Educator. 2006: 32 (6) 893-99. 11. Robbins et. al., Nutritionist Visits, Diabetes Classes and Hospitalization Rates and Charges Diabetes Care 2008 31 (4) 655-60. 12. Micklewaithe, A. et. al., The Business Case for Diabetes Self-Management Intervention in a Community General Hospital, Population Health Management 2011 Vol 15, 1-6. 13. Duncan, I. et.al., Assessing the Value of Diabetes Education. Diabetes Educ. 2009; Vol 35 (5) 752760. 14. Duncan, I. et.al. Assessing the Value of the Diabetes Educator. Diabetes Educ. 2011; Vol 37 (5) 638657
Volunteers Needed
Louise Butcher of ADA is looking for volunteers to assist with implementing programs within the African American and Hispanic/Latino communities. The ADA has specific programs that reach out to these at-risk populations. Live Empowered is a series of modules for African Americans and Por Tu Familia targets the Hispanic/Latino community. Help is needed in presenting the programs within faith-based settings as well as community sites. If you would like more information, contact Louise at ADA 1-203-639-0385. Steve Edelman, MD is bringing his TCOYD (Taking Control of Your Diabetes) Diabetes Conference and Health Fair toWorcester, MA. on Sat, Sept 21. The conference has a separate track for professionals, type 1s and type 2s. Professionals will earn 7.25 credit hours. The cost is $15.00 for patients and $45 for professionals including lunch. For more information, call TCOYD office: 800.998.2693 or www.tcoyd.org
INDUSTRY REPS PLEASE READ:
Cindy Kozak at the CT Dept. of Public Health has been working with Ann Kiwanuka, APRN, BC, Clinical Nursing Director, with the CT Dept. of Children and Families ( DCF). DCF has several children with type 1 or type 2 under their care. They are planning a diabetes program on Oct 7 from 8am-2 pm at the Dept. of Transportation in Newington. DCF is looking for industry reps to bring their pumps, meters and pens to demo at the conference during a “Hands on”!practice session. The goal is to increase the comfort level/experience the DCF nurses have with these types of devices. If you are willing to be a!part of this program please contact [email protected] or 860-560-5092!by Aug. 15.
Connecticut Alliance of Diabetes Educators Save the Dates: Future Meetings
General meetings – Location- Midstate Medical Center, Meriden Thursday, Sept 12, 2013 at 5:00 pm Speaker sponsored by Janssen Pharmaceuticals on SGLT-2 inhibitors Dinner provided Tuesday, October 22, 2013 at 5:00 pm, Speaker and dinner sponsored by Lilly on Transitioning from oral agents to Insulin Wed, November 6, 2013, All day ADA Diabetes Symposium for Healthcare Professionals At Crowne Plaza in Cromwell, CT
FYI: Board meetings will take place via conference calls
CADE Newsletter
Spring/Summer Edition, 2013
President’s Message
Hello! I hope you are all enjoying your summer, despite the mostly awful weather we have been having! As of July 1, 2013, CADE transitioned into its 2013 – 2014 program year, which will run through June 30, 2014. I am honored to serve as CADE President, and I am really looking forward to a fun and productive year. Membership dues are now being collected and can by paid by check or through PayPal. As of July 1st, 27 members have already taken advantage of the convenience of PayPal to renew their memberships. CADE dues are still just $50/ year, and CADE members receive many benefits, including: • The opportunity to network with over 100 local colleagues who work in the field of diabetes: • 6 meetings a year in a central Connecticut location (Meriden), many with dinner included • Annual Membership Directory distributed electronically in early fall !!Up-to-the minute educational offerings on topics of interest to members! ! Free use of our Resource Library with a variety of current books, DVDs, !Discounts to other diabetes-related activities, such as the Cardiometabolic Health Congress in Boston !Annual scholarship and Educator of the Year awards !! If you haven’t already, I encourage you to please renew your CADE membership today, and to invite a colleague to join us as well! I’m looking forward to seeing you at our first meeting of the year on September 12, 2013 at 5:00 p.m. at Mid-State Medical Center in Meriden. Sincerely, 2 Lisa Gilmore, RN, MSN, MBA, CDE 2
CADE Board of Directors 2013-2014
President Co-Presidents-Elect Treasurer Secretary Past President Members-at-Large Lisa Gilmore, RN, MSN, MBA, CDE Jean Kostak, MS, RD, CD-N, CDE Karen McAvoy, MSN, RN Mary Jo Farrelly, RD, CDE Kari Davis, RN, MSN, BC-FNP, CDE Beth Caffrey, MPH, RD, CDE Amy Sullivan, RN, MPH, CDE Kathy Wietrak, APRN, CDE
Nominating Committee Cindy Kozak, RD, CDE, MPH Sandy Micalizzi, APRN, CDE Committee Chairpersons Bylaws Hospitality Linda Ferro, MSN, APRN, CDE Pam Howard, APRN, CDE Diane Bussolini, RD, CD-N, CDE Lisa Pranger, RD, CDE Kathy Wietrak, APRN, CDE Louise Butcher Jill Ely, MSN, APRN, CDE Barbara Nadolny, RN, BSN, CDE Trish Comrie-Scheer, RD, CD-N, CDE Nancy Held, MS, RD, CDE
Legislative
Membership Newsletter Editor
Professional Education Sangeeta Ahuja, RD, CDE, CD-N Donna Hansen, BSN, RN, CDE Scott Hozebin Public Relations Resource Library Web Master Betsy Guadian, RN-BC, RD, CDE Diane DeMain, RN, MS Leigh Bak, MS, RN, CDE Molly Kirshner, RD, CD-N, CDE 3
3
Spring/Summer Edition, 2013
Message from the immediate past-President of CADE
Uncertain … Not known or established It seems fitting that the first two CADE meetings of 2013 addressed topics, which reveal the uncertainty of healthcare in our nation. Both the Affordable Care Act and Managing Inpatient Technology (CSII during Hospitalization) present new challenges and opportunities for providers, educators, and clients. As our first speaker, Thomas Buckley, RPh, MPH, explained, the Affordable Care Act was enacted with the intent of making healthcare more accessible and more affordable for Americans. However, the best way to achieve this goal while providing better care for individuals and better health for populations is yet to be determined. The second topic, Managing Inpatient Technology- a Taskforce Summary of current CSII during hospitalization in CT was moderated by Molly Kirschner, RD, CD-N, CDE, and Nancy Ryan, MS, RD, BC-ADM, CDE, CD-N. This first step involved sharing information regarding the current policies and procedures in CT hospitals for patients that use CSII. The discussion addressed the need for additional training of inpatient staff regarding CSII so that clients are safe in this environment utilizing this technology. Although not knowing exactly what lies ahead for our DSME programs, our inpatient components, our private industry members, and even our clients, CADE offers the opportunity for us to come together and share our findings. It enables members to learn about new initiatives that are successful. This may be an uncertain time for healthcare. But it’s also opportunity to continue to grow and improve. Respectfully Submitted, Beth Caffrey, MPH, RD, CDE, CD-N
4
4
Spring/Summer Edition, 2013
Kudos and Happenings for CADE Members
The 2013 Diabetes Educator of the Year : Sandy Micalizzi, APRN, CDE!!! The following poem was written in honor of Sandy:
It does my pancreas good to inject some new beta cells onto the list of Educators of the Year. In 2013, it was difficult but the choice was very clear. She has spoken of carbohydrates, exercise and meds What must she do to get it in their heads? Assisting her patients and helping her peers Could not even bring our EOY to tears. Speaking to the community or going to health fairs All while maintaining impeccable hair. When teaching a patient the insulin pump You will note that her mascara will not even clump! Pills, insulin, meters, pens, needles and diet If it will improve control she will have her patient try it. Being a local, state and federal activist Has our EOY looking for a good hair colorist. If your patients continue to eat candy don’t get in a tizzy Just call the 2013 Educator of the Year Sandy Micalizzi.
Sandy has been past co-president and active member of CADE, as well a member of various community and professional organizations. Presently she is clinical nurse specialist at the Heart Center of Greater Waterbury and has many clinical and educational experiences. CONGRATULATIONS SANDY! The 2013 $500 Education Scholarship recipient is Maureen Moore, RN, MA, CDE. Currently she volunteers at a free clinic providing diabetes care for about 40 patients that are uninsured or underinsured. She plans to use the scholarship to go to a national meeting. CONGRATULATIONS Maureen!
5
5
Spring/Summer Edition, 2013
More Kudos and Happenings for CADE Members
Leigh Bak published an article on Support Group Savvy in the March/April issue of Practical Diabetology. Linda Ferro, APRN, recently started a new job at Soundview Medical Associates in Norwalk. Lisa Gilmore RN, MSN, MBA, CDE was recognized with the Nightingale Excellence in Nursing Award from the William W. Backus Hospital on May 9, 2013 Donna Hansen, BSN, RN, CDE will be on the faculty as a lecturer at Housatonic Community College in Bridgeport. The course will focus on health and wellness and prevention of diabetes. The classes are Adult Ed. The link is: http://www.housatonic.edu/ce/Wellness/ Judy McCarthy and Reninca LaBella who work for Lifescan, a division of the J & J Diabetes Franchise, were recently awarded the “Presidents Circle of Excellence” for their high quality work in Connecticut. Lois Pelletier RN, CDE renewed her CDE this September for the 5th time! Betsy Gaudian is looking for a position is diabetes education. Please email her if you can help [email protected] Charlotte Hungerford Hospital renewed its ADA Recognition in Feb 2013.
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6
Other Dates to put on your calendars:
Step Out: Walk to Stop Diabetes - one great walk, 4 sites! Savin Rock Boardwalk, West Haven, 9/21/13 Ocean Beach Park, New London, 9/29/13 Bushnell Park, Hartford, 10/5/13 Fairfield County, 10/6/13 – West Hill High School, Stamford, CT Online registration will be available mid-May at www.diabetes.org/stepout; for more information call the ADA office and you will be connected to the appropriate walk coordinator. ADA Endocrinology Seminar – September 19, 2013, Dr. Silvio Inzucchi is the keynote speaker This will be held at the Crowne Plaza Hotel, Cromwell, CT. For more information, contact Louise Butcher, 203-639-0385 AADE National Meeting August 7-10 Cardiometabolic Health Congress October 2-5, Boston, MA ! !!
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7
This group of representatives met with Dept of social services Medical Director Robert Zavoski MD and several other policy makers. The meeting was held on 1/9/13 at Dept of Social Services in Hartford. The purpose was to discuss reimbursement for DSMT by Ct State Medicaid. Each of our group presented a topic to include: Why we here and ADA's interest, The essentials of diabetes care, What is DSMT, What is a CDE, What is a credentialed program, How is it reimbursed by Medicare and Ct state insurance mandate, benefits from physician perspective. The results of the meeting were that from a clinical perspective they understand the benefit. But there are laws that our state Medicaid plan falls under that exclude education from coverage. 35 states have Medicaid coverage so our next step is to explore how other states are covering it. Since the meeting Barbara Nadolny has continued to correspond with the Medical Director and is slowly making headway. Pictured are Stephen Habbe ADA
Advocate, Lois Pelletier RN CDE, Sally Cooney MPH RN CDE, Barbara Nadolny RN CDE, Egils Bogdanovics MD.
Spring/Summer Edition, 2013
Diabetes Self -Management Education 2013 Cindy Kozak, RD, MPH, CDE, CT Dept. of Public Health
Diabetes self-management education (DSME) is the ongoing process of facilitating the knowledge, skills and abilities necessary for diabetes (and prediabetes) self-care. It is a critical element of care for all people with diabetes and is necessary to prevent or delay the complications of diabetes. (1-5) Promoting access to DSME is a core objective of the Connecticut Diabetes Prevention and Control for 2013-18. Currently only 49.5% of adults with diabetes receive self-management education (2008-10 BRFSS) Connecticut data An analysis of Connecticut data showed that people with diabetes are more likely to obtain comprehensive diabetes clinical care (including eye exams, foot exams and influenza vaccinations) if they attend DSME (56.1%) vs. 40.2% for those who never attended DSME. (6) These preventive care practices are known to prevent or delay costly diabetes complications. Diabetes Diagnoses in Emergency Departments (ED) Diabetes is a leading cause of ED Visits in the US. Among US adults, about 6.4% of ED visits or 733,600 visits had diabetes with complications as the first listed diagnosis in 2009. In comparison, 5.4% of ED visits among adults were for non- specific chest pain and 3.5% were for congestive heart failure. (7) However, evidence from the national Agency for Healthcare Quality and Research (AHRQ) suggests that many ED visits with diabetes are preventable. One such study revealed that increased adherence to diabetes medications can reduce the rate of ED visits by over 46%. (8) Medication adherence is a key topic addressed in DSME. According to the American Diabetes Association the prevention of acute complications of diabetes requires continuing medical care as well as ongoing patient self-management education and support. (9) In the Medicaid population results from a study by Balamurugan et. al.“clearly suggest that DSME decreased health care use among Medicaid recipients, particularly hospital admissions and ED visits”. (10)
Spring/Summer Edition, 2013
Hospitalizations Robbins et.al studied educational visits in eight public safety net primary care clinics vis a vis hospitalization rates and charges. Their “most important finding is that both diabetes classes (and nutritionist visits) were strongly associated with reductions in patient hospitalizations and hospital charges”. (11) In an article by Micklethwaite published in Population Health Management in 2012 the author described a DSME intervention that resulted in significant improvement in blood sugar control and saved the hospital an average of $551 per active patient per year, primarily through reducing hospital visits. This study was able to demonstrate that the hospital was able to avoid more costs than it incurred. (12) Hospital Re-Admissions For hospitals striving to maintain cost by decreasing hospital readmissions, DSME can have a positive impact. In a study by Duncan et. al., DSME resulted in a 34% decrease in hospital readmissions. A 5.7% decrease in overall costs per year, and a 12% decrease in costs after 3 years, for those people with diabetes who received diabetes education versus those that did not was also shown. (13) Other cost information Duncan’s work also showed that commercially insured members who participated in DSME cost on average 5.6% less than members who do not access DSME (13). Another article by Duncan concluded people with diabetes who had DSME provided specifically by a credentialed diabetes educator in an accredited/recognized program are likely to show lower cost patterns when compared to a control group of people with diabetes who did not get DSME. People with diabetes who have multiple episodes of DSME are more likely to receive care in accordance with the
recommended guidelines and to comply with diabetes related prescription regimens, resulting in lower cost and utilization trends. (14)
References 1. Brown SA. Interventions to promote diabetes self-management: state of the science. Diab. Educ. 1999; 25 (6) suppl 52-61. 2. Norris, SL et al Self-management education for adults with type 2 diabetes: a meta analysis of the effect on glycemic control. Diabetes Care. 2002: 25 (70; 1159-71. 3. Gary, GL. Et al Meta- analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Educ. 2003; 29 (3) 488-501. 4. Deakin T. et al Group based training for self-management strategies in people with type 2 diabetes. Cochrane Datebase Syst Rev 2005:2: CD003417. 5. Renders, CM et al, Interventions to improve the management of diabetes in primary care, outpatient and community settings: a systematic review. Diabetes Care. 2001: 24 (10)1821-1833. 6. CT DPH data on CT Behavioral Risk Factor Surveillance System, 2008-10. 7. National Emergency Department Samples, Agency for Healthcare Research and Quality. Data computed by personnel in CDC’s Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Available at http://www.cdc.gov/diabetes/statistics/emergency_national.htm) 8. (Encinosa, W. et. al. (2010). Does Prescription Drug Adherence Reduce Hospitalizations and Costs? The case of Diabetes. Advances in Health Economics and Health Services Research, 22, 151-173. (AHRQ 11-R008). 9. American Diabetes Association. (2012) Diabetes Care, 35, (Supplement 1), S11-63. 10. Balamurugan, A. et. al., Diabetes Self- Management Education Program for Medicaid Recipients. The Diabetes Educator. 2006: 32 (6) 893-99. 11. Robbins et. al., Nutritionist Visits, Diabetes Classes and Hospitalization Rates and Charges Diabetes Care 2008 31 (4) 655-60. 12. Micklewaithe, A. et. al., The Business Case for Diabetes Self-Management Intervention in a Community General Hospital, Population Health Management 2011 Vol 15, 1-6. 13. Duncan, I. et.al., Assessing the Value of Diabetes Education. Diabetes Educ. 2009; Vol 35 (5) 752760. 14. Duncan, I. et.al. Assessing the Value of the Diabetes Educator. Diabetes Educ. 2011; Vol 37 (5) 638657
Volunteers Needed
Louise Butcher of ADA is looking for volunteers to assist with implementing programs within the African American and Hispanic/Latino communities. The ADA has specific programs that reach out to these at-risk populations. Live Empowered is a series of modules for African Americans and Por Tu Familia targets the Hispanic/Latino community. Help is needed in presenting the programs within faith-based settings as well as community sites. If you would like more information, contact Louise at ADA 1-203-639-0385. Steve Edelman, MD is bringing his TCOYD (Taking Control of Your Diabetes) Diabetes Conference and Health Fair toWorcester, MA. on Sat, Sept 21. The conference has a separate track for professionals, type 1s and type 2s. Professionals will earn 7.25 credit hours. The cost is $15.00 for patients and $45 for professionals including lunch. For more information, call TCOYD office: 800.998.2693 or www.tcoyd.org
INDUSTRY REPS PLEASE READ:
Cindy Kozak at the CT Dept. of Public Health has been working with Ann Kiwanuka, APRN, BC, Clinical Nursing Director, with the CT Dept. of Children and Families ( DCF). DCF has several children with type 1 or type 2 under their care. They are planning a diabetes program on Oct 7 from 8am-2 pm at the Dept. of Transportation in Newington. DCF is looking for industry reps to bring their pumps, meters and pens to demo at the conference during a “Hands on”!practice session. The goal is to increase the comfort level/experience the DCF nurses have with these types of devices. If you are willing to be a!part of this program please contact [email protected] or 860-560-5092!by Aug. 15.
