Member Meeting Summaries

check out our Picture Album where we have some additional pictures from GAADE Events.


Mary Sullivan, AADE Diabetes Educator of the Year speaks at July 24th 2010 GAADE Member Meeting

Mary SullivanOn July 26, 2010 the members of Greater Atlanta Association of Diabetes Educators were treated to an entertaining and insightful presentation by Mary Sullivan, NP, CDE. , AADE Diabetes Educator of the Year 2010.   Ms. Sullivan works as an inpatient diabetes Clinical Nurse Specialist at University of California San Francisco Medical Center.

During her tenure as AADE’s Diabetes educator of the year Mary has plans to visit over a dozen chapters (local networking groups) before the year is out.  “Every place I’ve been to is different and I learn something no matter where I go” says Sullivan about her travels so far this year.

Mary believes that it is not only her job to teach her patients about diabetes but to “change people’s hearts and minds about diabetes”.  Certified diabetes educators are the critical “link” between patients and a healthcare system that can be overwhelming says Sullivan.   It is her hope that the new healthcare reform changes will translate into more people having viable health insurance.   If this is the case, there will be a greater demand for diabetes educators to care for the more than 23 million individuals who have diabetes.  Sullivan posed the question “ Will there be enough diabetes educators to meet the demand”?

Historically clinicians have been self taught.  Mary suggests that there needs to be more innovative education programs where professionals can get the information and training they need to pursue a career in diabetes education. 

Using the AADE competencies for diabetes educators as a guide, Mary developed a grassroots program to educate health care professionals about providing comprehensive diabetes education and about how to become a diabetes educator.  The program was held on two consecutive weekends to accommodate participants work schedules.  The education was delivered using varied teaching techniques including didactic and webcast lectures, self study homework assignments and live learning stations where basic diabetes skills were taught.  

Mary enlists the help of multiple health care professionals and students to carry out this ambitious, grant funded program.  To date, her program has educated over 300 students. (55% RN’s, 20% RD’s, 10% Pharmacisits). Pre and post evaluations show that attendees gained confidence in basic and advanced diabetes education skills including insulin administration, blood glucose monitoring, carbohydrate counting and pharmacology.

 


 

dr.hibbs

Dr. Hibbs, clinical psychologist

At the October 6, 2009 membership meeting. Dr. Stanley Hibbs, clinical psychologist spoke about Motivational Interviewing and other behavior change strategies. 

Motivational interviewing, created 20 years ago by psychologists, William Miller and Stephen Rollnick to treat clients with addictions,  is based on the knowledge that most people have mixed feelings (ambivalence) when it comes to behavior change.  Intellectually a person might know that losing weight would improve their health, but translating that knowledge into action is where most people get stuck.  As diabetes educators we need to resist the “righting reflex” which is our tendency to offer solutions that will “fix” patients health issues.  Instead, MI instructs educators to become skilled at identifying “change talk” in what their clients are telling them.  “Look for things that a client says that expresses positive thoughts toward change” says Hibbs, “you can do that by listening for the words “want” “wish” or “like”.       

The client’s desire to change or not to change must be respected.  And rather than “imposing” change on the patient, the educator needs to “foster” behavior change by helping the client make a connection between something they want and a positive behavior change.  Reinforcing even very small changes is essential too.

A helpful tool Hibbs described is a Motivational Ruler which is a line of questioning that helps measure the strength of the client’s s motivation.  The conversation might be: 

“On a scale of 1-10, how important is it for you to get your A1C down”?    If the person says “7” the educator can reply, “why not a 4 or 5”?  This unexpected response (choosing a lower number on the scale) from the educator might challenge the client to think more deeply about why making a behavior change is important to them.   It may illicit some personal and more meaningful incentives for making a change, rather than just because the diabetes educator told them to do so. 

Dr. Hibbs also described three skills that are integral to motivational interviewing: 

  • 1.  Asking open ended questions:

    Closed question:                                     Open ended question:
    Do you like Atlanta?                                 What do you think of Atlanta?
    Did you exercise this week?                    How is the exercising going?
    Are you satisfied with your A1C?             How do you feel about your A1C?

  • 2. Listening with Reflection:  “This means showing empathy and understanding of the clients thoughts” states Dr. Hibbs.  “It is not agreeing, disagreeing or giving advice, but restating what the client has said and often adding something that helps the client move in a positive direction”.

    Example Patient:  “My A1C is way too high.  Nothing I do makes a difference”
    Possible reflections:
    “You’re really concerned about the A1C”
    “You’re really feeling stuck on this one”
    “You’re trying but nothing seems to be working”

  • 3.  Skillful Informing:  Dr. Hibbs states “there is an important place in MI for giving information and feedback.  However, clients are more open to recommendations and information if the healthcare provider does the following:

    Asks permission:   “I have some concerns about your A1C, is it OK if I share them with you”?
    Give alternatives:   “There are a lot of ways we could address your diabetes: medications, diet, exercise.  Which one would you like to focus on first”?
    Sharing what others do:  “I find that a lot of my clients find it helpful to carve out 2-3 specific times per week to exercise.  How does that sound to you”?


    Legislative chairperson Denine Rogers shares the latest on HR 2425 - Medicare Diabetes Self Management Training Act of 2009 at the October 6, 2006 membership meeting.  She urged all members to contact their district representatives and/or attend a town hall meetiing to urge them to support this bill.  Denine will be stepping down from being chairperson for GAADE legislative committee and will be taking on the role as President of AADE's African American Specialty Practice Group.  Congratulations Denine!  We are proud of you!".

    Please Read HR 2425 --> View Bill

 


July 27th 2009 Dr. Guillermo E. Umpierrez speaks on controlling cardiovascular risk in diabetes at July 27 GAADE membership meeting (for additional reading and reference on this topic, we have posted two articles and a power point presentation prepared by Dr. Umpierrez for you to download. View Articles

Dr. Guillermo Umpierrez, MD

GAADE members were treated to a presentation by Dr. Guillermo Umpierrez, MD at the July 27 membership meeting.  Dr. Umpierrez is director of Grady Hospital Clinical Research Center , director of Grady Health System Diabetes & Endocrinology program as well as Professor of Medicine at Emory University.   Dr. Umpierrez’s presentation focused on the question “Does strict glycemic control improve cardiovascular risk in diabetes?”.  As diabetes educators we are concerned with this question since 80% of all diabetic mortality is related to atherosclerosis and 50% of patients newly diagnosed with Type 2 diabetes have coronary heart disease.   His talk focused on the results from several recent randomized controlled trials .   He began with the observation that DCCT/EDIC data suggests that “A1C is a good biologic correlate to microvascular disease complications but a less powerful one to macrovasular disease”  and this is due to the multi-factorial nature of cardio vascular disease.    Why can’t we decrease cardiovascular disease just by lowering A1C?  Dr. Umpierrez first pointed out that clinicians have done a good job lowering A1C and sited data from www.ncqa.org showing percentage of adult patients achieving A1C goals has more than doubled since 1997.  But he pointed out that the EDIC study and UKPDS follow up data suggest that sustaining a reduction of A1C using intense therapy is difficult ( both DCCT and UKPDS study groups sustained an average A1C under seven for 6 and 5 years respectively before they began to gradually rise to above 8).   He then turned to the ACCORD (Action to Control Cardiovascular Risk in Diabetes) which set out to study whether intensively lowering blood glucose would reduce the risk of cardiovascular events such as heart attack, stroke and death in people with Type 2 diabetes who have a known risk for CVD events.  Approximately 10,000 patients (including 180 from Emory) with type 2 diabetes were evaluated, with roughly half randomized to an intensive strategy, with a target A1C level of <6.0%, and the other half to a standard therapy with target A1C of 7.0–7.9%.  Treatment used to reach glycemic targets was not “one” specific regimen but all commercially available diabetes agents were used alone or in combinations.   Median A1C level achieved in the intensive treatment group was 6.4 vs. 7.5% in the standard group. There were 257 deaths in the intensive treatment group compared with 203 within the standard treatment group—a difference of 54 deaths, or 3 per 1,000 participants each year.  This part of the trial was ended early due to these findings but the blood pressure and lipid arms of the study continues until the study ends as planned in June 2009.  The cause of the increased mortality in the intensive treatment group is under question. Some speculate increased incidence of hypoglycemia in the intensively managed group may have contributed.  Because no specific pharmaceutical treatment was used in the intensive treatment group, no one agent has been focused on as a possible culprit.   Because of these findings, clinical practice recommendations for A1C remain at < 7% however results from ADVANCE and VADT will be important to do a full assessment according to Dr. Umpierrez.   Based on current evidence striving for an A1C lower than 6% should be reserved to young patients with lower risk of cardiovascular disease and those with a shorter duration of type 2 diabetes.  The continuation of the blood pressure and lipid arms of this study will provide important information that will guide clinical practice recommendations for these parameters.  This part of the study is comparing a combination of fibrate with statins versus using statins alone to help lower lipid levels to target.

Dr. Umpierrez concluded his talk with the following list of “Conclusions & Implications”:

  • Comprehensive care involves treatment of all modifiable CVD risk factors
  • DCCT and UKPDS follow up studies demonstrate intensive glycemic control reduces micro-and macrovasular disease
  • Glycemic control seems to provide CVD benefit if initiated early in the disease course
  • Intensive treatment of BG and lipds reduces the impact of glycemic control on micro- and macrovascular complications
  • Glycemic goals for most patients should remain unchanged, i.e. targeting A1C <7%
  • Higher  A1C targets are acceptable for patients with hyoglycemia unawareness and/or a known history of severe hyypoglycemia, established CVD, and in older frail patients
Lower A1C targets are appropriate in patients with shorter duration of diabetes and those without established

 

Dr. Bruce BodeDr. Bruce Bode

May 18th 2009 - Dr. Bruce Bode speaks on value of CGMS at May 18 membership meeting.
GAADE members heard a presentation by Dr. Bruce Bode from Atlanta Diabetes Associates at the May 18 membership meeting held at Wellstar Wellness Center.  Dr. Bode presented  the findings of a multi-centered study he participated in.  The study was sponsored by Juvenile Diabetes Research Foundation and it investigated the value of continuous glucose monitoring(CGMS) in the management of type 1 diabetes mellitus.  The study was published in the The New England Journal of Medicine on October 2, 2008 (vol. 359).  Below is an abstract of the study findings that Dr. Bode presented.   Following his presentation, Dr. Bode presented case studies of several patients that benefited from CGMS with assistance from  Carey Schuman of Medtronic Minimed.

ABSTRACT –  from New England Journal of Medicine,  October 2, 2008.  Volume 359:1464-1476

Background: The value of continuous glucose monitoring in the management of type 1 diabetes mellitus has not been determined.

Methods In a multicenter clinical trial, we randomly assigned 322 adults and children who were already receiving intensive therapy for type 1 diabetes to a group with continuous glucose monitoring or to a control group performing home monitoring with a blood glucose meter. All the patients were stratified into three groups according to age and had a glycated hemoglobin level of 7.0 to 10.0%. The primary outcome was the change in the glycated hemoglobin level at 26 weeks.

Results The changes in glycated hemoglobin levels in the two study groups varied markedly according to age group (P=0.003), with a significant difference among patients 25 years of age or older that favored the continuous-monitoring group (mean difference in change, –0.53%; 95% confidence interval [CI], –0.71 to –0.35; P<0.001). The between-group difference was not significant among those who were 15 to 24 years of age (mean difference, 0.08; 95% CI, –0.17 to 0.33; P=0.52) or among those who were 8 to 14 years of age (mean difference, –0.13; 95% CI, –0.38 to 0.11; P=0.29). Secondary glycated hemoglobin outcomes were better in the continuous-monitoring group than in the control group among the oldest and youngest patients but not among those who were 15 to 24 years of age. The use of continuous glucose monitoring averaged 6.0 or more days per week for 83% of patients 25 years of age or older, 30% of those 15 to 24 years of age, and 50% of those 8 to 14 years of age. The rate of severe hypoglycemia was low and did not differ between the two study groups; however, the trial was not powered to detect such a difference.


 

January 26, 2009 GAADE members met with local dietitians (Greater Atlanta Dietetic Association) in a combined membership meeting at the Wellstar Development Center last Monday night. The two professional groups were treated to a presentation from Pauline Duker, Director of Education and Recognition at the American Diabetes Association (ADA). Ms. Duker’s presentation highlighted key changes in the 7th edition application process and requirements outlined for Diabetes Self Management Education programs by the ADA.

http://care.diabetesjournals.org/cgi/content/full/32/Supplement_1/S87 Some of the primary changes involve staffing requirements including a program can be a single discipline and only instructional staff . Another significant change involves the requirement that the DSME program provide a support plan for each client. This could involve linking a patient to a support service like a gym or support group in their local community as a means to promote permanent behavioral change. This support plan must be communicated to the provider and documented. She also discussed strategies for maintaining recognition and remaining “Audit ready” and identified the most common audit findings that negatively impact audit outcomes.. Her talk identified helpful resources that are available to support coordinators and diabetes educators on the ADA website (www.diabetes.org)

 

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