Community Based Diabetes Education

Debra Massaro Radford University

DSME

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Diabetes Education is now known as Diabetes Self-Management Education (DSME) by the American Association of Diabetes Educators (AADE’s) and the American Diabetes Association (ADA) An essential component of care to achieve desired outcomes between patient and the health care team

• A diagnosis of diabetes means a life-long challenge of stabilizing blood glucose • It is not possible for the newly diagnosed diabetic to process the information all at once • Busy practitioners typically spend about 15-20 minutes educating the diabetic patient • A referral is needed for DSME classes

• DSME classes can be taught by Certified Diabetes Educators (CDE’s), Registered Dieticians (RD’s), Registered Nurses (RN’s), and lay persons - -Programs accredited by the ADA are of the highest quality standards • The World Health Organization has recognized that Type 2 diabetes is on the increase and must become a number one health concern • Medicare reimburses for approximately 12 hours of nutritional education, setting industry standards for private carriers

• Craig County population is approx. 5190, estimated population > 65 is 16.9% versus state at 12.5% • Craig County is in the Allegheny Health District.

• The Allegheny Health district surpassed the state rate of diabetes reporting 8.2% versus state rate of 7.7% between 2005 and 2009.

Craig County Profile • One Health Department for WIC Patients, Immunization and Family Planning Clinics • One main Pharmacy • One Dental Clinic • One Federally Qualified Health Clinic • Twenty-nine miles to the nearest Hospital

ARC Goal: •

Increase job opportunities and per capita income in Appalachia to reach parity with the nation

Strategies: •

Support projects which include wellness and healthcare prevention efforts

• Continue efforts to place doctors and other medical professionals in medically underserved areas through physician and other recruitment programs

ARC Project Applications include the following: Identification of Grantee Identification of area to be served Statement of project objective Description of project rationale Description of work to be undertaken with description of grant and matching funds • Description of output and outcome benefits • • • • •

Carilion Clinic has a specialized team of Certified Diabetes Educators, Registered Dieticians, and Nurses dedicated to conducting high quality DSME Community Classes

Proposed Intervention— • DSME classes offered in a convenient local facility during evening hours • DSME classes consist of 4 weekly meetings with data collection on patients HgA1C, Lipid levels, patient BMI and 3-month reunion class for additional sero-testing • Group classes offered at appropriate health literacy level with cultural adaptations • Classes include stimulating breakout discussion groups, guest speakers, goal setting, hands on cooking opportunities for nutritional meal prep and food tasting • Incentive promotional prizes offered for participation • Child care and transportation offered as allowed through grant

Intervention Cont’d • Dietician Intern Volunteers to be provided by Virginia Tech Department of Human Nutrition Foods and Exercise • Project will recruit volunteer participation from Craig County area • Classes to be held on an Annual/ rotating Quarterly basis • Classes will be ongoing offering continuing education to Adult Type II Diabetics and Pre-diabetics in the Craig County Area

BENEFITS OF DSME CLASSES • Teach problem solving skills • Education can continuously be put to use for decades of living with the disease • Long term outcomes include decreased morbidity/mortality • Increased productivity • Improvement in HgA1C and Lipid Levels

New Castle Manor - -Designated Location • Senior Living Facility provides elder low-income housing subsidized by the U.S. Department of Housing and Urban Development • Available classroom space at no cost for DSME classes • Convenient New Castle/Craig County location • Attached kitchen for DSME meal preparation

Future Implications • Residents of Craig County have an unmet need for public transportation among the elderly and disabled FOURSQUARE INTEGRATED TRANSPORTATION (2011) •

A bus owned by the Monroe County Health Clinic could be taken over by Craig County for this purpose should funding be available for driver and automobile insurance (R. Flora personal communication, April 10, 2013)

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The Craig County Health Department has a need for an ongoing Dermatology Clinic. This could be provided by funding for an APRN

• Diabetes Self-Management Education classes offered soon in this area • Diabetes classes are fun and informative, offering helpful lifestyle tips • All Type II Adult diabetes and pre-diabetes patients are welcome (ages 30-80 yrs).

• Hoping to reshape Craig County’s future by remolding the present

References American Association of Diabetes Educators. (2013). AADE7 self-care behaviors. Retrieved April 21, 2013, from http:// www.diabeteseducator.org/ProfessionalResources/AADE7/ American Diabetes Association. (2013). Overcoming disparities: Reducing the burden of diabetes complications. Retrieved April, 26, 2013 from http://google.diabetes.org/search? site=Diabetes&client=default_frontend&sort=date%3AD%3AL %3Adl&entqr=0&oe=UTF-8&ie=UTF-8&ud=1&proxystylesheet=default_fro ntend&output=xml_no_dtd&q=DSME+Community+Classes Appalachian Regional Commission. (2013). The appalachian regional commission. Retrieved February 7, 2013, from http://www.arc.gov/ Carilion Clinic. (2013). About carilion clinic. Retrieved March 20, 2013, from http://www.carilionclinic.org/about-carilion-clinic Diabetes Initiative. (2009). A national program of the robert wood johnson foundation. Retrieved April 1, 2013, from http://www.diabetesinitiative.org/index.html

References Cont’d.

FOURSQUARE INTEGRATED TRANSPORTATION PLANNING. (2013). Craig county, va transit feasibility study. Retrieved April 13, 2013, from http://foursquareitp.com/craig-county-transit-feasibility-study/ Medicare.gov. (2013). Nutrition therapy services. Retrieved April 26, 2013, from http://www.medicare.gov/coverage/nutrition-therapyservices.html U.S. Department of Commerce United States Census Bureau.

(2013). State and county quick facts. Retrieved March 20, 2013, from http://quickfacts. Census.gov/qfd/states/51/51045.html Virginia Department of health. (2012). Diabetes in virginia.

Retrieved April 2, 2013, from http://www.vdh.virginia.gov.ofhs/prevemtion/diabetes/ documents/2012/pdf/Diabetes%20Burden%20Report1.pdf

References cont’d World Health Organization. A. (2013) 10 facts about diabetes. Retrieved April 26, 2013 from http://www.who.int/features/factfiles/ diabetes/en