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Diabetes Education: Do You Know Everything Patients Need You to Know?


It's hard to imagine how a nurse caring for patients wouldn't encounter people with diabetes, which is why diabetes education for nurses is so important.

[caption id="attachment_57261" align="alignleft" width="200"]diabetes education - Julie Stefanski, RDN Julie Stefanski, RDN[/caption] "According to the CDC, 30.3 million Americans have diabetes and another 84.1 million have prediabetes," said Julie Stefanski, MEd, RDN, CSSD, LDN, CDE, FAND, a national spokesperson for the Academy of Nutrition and Dietetics, and a speaker for our Diabetes Educator Certification Review course for nurses and dietitians interested in diabetes education. "Understanding diabetes and how to help people manage their condition can help avoid serious complications that can occur when blood sugar levels are poorly controlled." Different diabetes types impact all ages, from children to the elderly, according to Jamie Dillinger, MSN, CRNP, CDE, who works in a private endocrinology practice in Paoli, Penn.

Type 1 diabetes affects children, and millennials are getting what's called latent autoimmune diabetes in adults, also known as LADA. Age of onset for LADA tends to be older than 30 years, according to a review published in 2018 in the Diabetes and Metabolism Journal.

Treatment for LADA differs greatly, depending on clinical intuition and knowledge of the caregiver. Because so little is widely known about LADA, providers often misdiagnose it as type 2 diabetes mellitus. Unfortunately, treatments commonly used for type 2 diabetes can worsen the autoimmune process and result in faster progression to insulin dependence for LADA patients, the study authors wrote. Type 2 diabetes is increasing at an alarming rate as people get older and put on weight, said Dillinger, who also is a speaker for our Diabetes Educator Certification Review course. A nurse for decades who was diagnosed with diabetes more than 30 years ago, Dillinger said she was exposed to patients with the chronic disease early in her career while working in a nursing home, later as a critical care nurse and when she worked for the Medtronic corporation, a maker of diabetes equipment that includes wearable technology that continuously monitors glucose levels.

A lot to know

[caption id="attachment_57262" align="alignright" width="200"]diabetes education - Jamie Dillinger, CRNP Jamie Dillinger, CRNP[/caption] There's a lot that nurses that nurses need to know about diabetes education themselves before they educate patients, and that knowledge needs to be up to date. There are 13 drug categories in diabetes, according to Dillinger. "And within those 13 drug categories are at least four to five drugs per category," she said. Fast-paced technology innovation also is happening in diabetes. "Eleven years ago when I worked for Medtronic, they were doing the first sensor technology," Dillinger said. "So instead of doing finger sticks, sensors are reading blood sugar levels. Now it's measuring blood sugars every three minutes."

Monitoring that used to be done in the practice setting is now in the hands of patients, who also need diabetes education, she said.

Diabetes can put people at risk for many other health issues. For example, adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Patients with diabetes also are at higher risk for retinopathy, kidney disease, renal failure and nerve disease, Dillinger said. A large part of diabetes education, prevention and management has to do with lifestyle, including diet and exercise. But the dietary piece can be challenging for patients and even providers to understand, according to Dillinger. "When I first got diagnosed with diabetes, I went to a dietitian and I walked out of there and thought, 'My God. I work critical care and I didn't understand a word that woman said,'" Dillinger said. "If you don't understand what and how you're eating and don't understand how your medication works, you're not going to be able to self-manage."

Need for nurses who understand complexity

It's hard to find nurses who are certified diabetes educators (CDEs), according to Dillinger, and the need is great in many practice settings from diabetes education and care programs to primary and acute care. "Obtaining certification as a diabetes educator can open doors to jobs that require a CDE in order to hold the position," Stefanski said. "Teaching diabetes self-management education classes to groups as a nurse typically requires a CDE if it is an accredited program." The reward for nurses to get certified is having an important impact on patients with diabetes. "Nurses who have a professional or personal interest in improving the health of those with diabetes will really be empowered by all the strategies they can use to help others manage their diabetes," Stefanski said.

"Committing to certification takes a simple interest in gaining knowledge to the next level. Studying for and then passing the certification exam is demonstration of skills that can be shared with both patients and employers," she said.

One of the benefits of the Diabetes Educator Certification Review course for nurses is gaining practical application of concepts as soon as their next shifts. "During each class, we ask learners to answer poll questions to assess their level of knowledge prior to completing our webinar," Stefanski said. "One of my nutrition questions focuses on how to carb count one particular sugar substitute. About 50% of learners miss the answer during the live webinar. But soon after that question, we cover that same information and educate participants about an area of nutrition they weren't aware of. Nutrition is one of the areas of diabetes care that patients are often most concerned about, but also most confused about.

"It's very easy to find opportunities to apply the knowledge gained in this diabetes review course very soon after learning it," Stefanski said.

Becoming a CDE or seeking diabetes education can help nurses put the current diabetes knowledge to use when caring for patients, according to Dillinger. "They're not getting that in a nursing program," she said. "I didn't get it in my NP program. The more you know, the more you're empowered and the more you can empower your patients." The need for nurses and other providers who are educated in diabetes isn't going away, according to Stefanski. "Each year, 1.5 million adults are told they have diabetes," she said. "Nutrition misinformation is abundant on social media, so it's important for nurses to know the right answers about diabetes so that they're providing help and not harm to people who may be confused about what to eat."

Take these courses to learn more about diabetes education and care: