SARAH: Hello and welcome back to the Qi Hub video series. Um, I am your host, Dr. Sarah Adkins. And joining me today is your favorite and our favorite diabetologist. Dr. Amber Healy. Welcome Dr. Healy. 

AMBER: Thanks. It's easy to be the favorite when you're the only one. 

SARAH: That's a great way to start this video. Okay. That was perfect. That's perfect. So today we are going to talk about diabetes self-management education and I think it's a topic that is not discussed enough and one that the QI hub is now working on around the region. So we've invited Dr. Healey to get a provider perspective on diabetes self-management education, and thoughts around from a provider what we can do to help our patients in this. So Dr. Healy, thank you for talking with us about diabetes self-management and tell us about diabetes self-management. So D-S-M-E-S give us, give us what D-S-M-E-S is. 

AMBER: So as you had mentioned in the intro, diabetes self-management education and support. 

SARAH: I, I always forget the s that's why I didn't add the s 

AMBER: That's Fair. It's fair. It's fine. But it is a program, uh, for patients with diabetes. Uh, who, outside of seeing the, the healthcare provider. Uh, it is usually a, an individual that has additional training that had been certified in, uh, the program and they may have previously had a background as um, an RN or an RD. And they have spent several patient facing hours in the diabetes realm and sat for an exam before they, uh, are certified to provide this training. 

SARAH: Cool. So there are leaders in this diabetes education. That are certified and have done many hours of training to sit there and help patients with diabetes learn more about, um, their own care for themselves. 

AMBER: Right. 

SARAH: Yeah. Okay. What are the pieces of D-S-M-E-S? Like what, what is included in the training? 

AMBER: It includes seven self-care behaviors. Um, so it's not just about food. 'cause there's a misnomer around that. That a lot of patients think that I'm not going somewhere for someone to tell me what I can and can't eat. They are not there to be the food police. They actually give, provide strategies around healthy eating, but while recognizing people have lives, there are holidays, there are birthdays. How do you not sabotage yourself at a holiday? And how do you create support around you and your family? And when you have that heckler in your family that wants to be like, "oh my God, why is that on your plate?"

SARAH: That's awful. 

AMBER: When you have, you know, your one piece of pumpkin pie at Thanksgiving. How to handle that. 

SARAH: That's fantastic. I think that's what, that would be so helpful for someone who has diabetes. I think that would be the worst, to have the food police.

AMBER: There's just so much stigma around the food. 

SARAH: Yeah. Interesting. 

AMBER: I mean, even this morning I was scrolling through Doximity, which is the providers, right? There was an article about the, these newer pops with the um you know, with the probiotics and that. And somebody in the comments wrote, in my clinic we call Coca-Cola the diabetes juice. I'm like, that's not okay. 

SARAH: Yeah. It's not fair. 

AMBER: That's not okay. 

SARAH: It's not fair. 

AMBER: We still see a lot of that stigma and it's understanding why people feel that way. I mean even some TV series where they, I won't name it, call it out by name, but they talked about fudge causing diabetes. Like it, it's no wonder that people just are so reluctant to go and receive this thinking that they're gonna be in trouble. Yeah, but there's more to it. I mean there's seven self-care behaviors that they, that they address. They do talk about healthy eating. Yes. They talk about activity. They talk about uh, coping mechanisms. They talk about monitoring medication, complication monitoring, all the things. 

SARAH: So it's like building self-confidence and also working with people around you to give you support. And not cut you down. I think that's huge. I think that's so important with diabetes. 

AMBER: And I, and I will frame it with patients like, yeah, this, this is meant to support you in what you're doing to keep yourself healthy.

SARAH: That's awesome. 

AMBER: Instead of saying, this is just about... 

SARAH: ...Telling you what you can and can't eat. 

AMBER: Right. 

SARAH: Okay. Great. I think that's awesome. How often, as a provider, how often would you recommend uh, D-S-M-E-S to your patients? 

AMBER: So actually there's guidelines in the A DA standards of care around that. And the times that they recommend are at diagnosis annually. Uh, when complicating factors develop. Like if somebody has a new diagnosis of retinopathy or you know, they're starting to see some protein in their urine. Something along those lines. Then that'd be a good time to refer. And then when there's transitions in life or care. You know, so every new patient that comes into my office as a referral. I ask the question, have you had diabetes education? And sometimes it's yes. Sometimes it's no. Sometimes it's, "yeah and I already know what I'm supposed to do, but I don't do it". 

SARAH: Yeah. What do you do with that As a provider? 

AMBER: I just still encourage that. But I've thrown it, you know, I've offered it, but I might at that time go, well maybe if now's not the right time for you. We can discuss it again. Make keeping that open for that possibility in the future. And sometimes patients, after they've worked on things on their own, they go, "Hey, I want a referral". And you know, they have chosen it on their terms at that point. 

SARAH: That's awesome. Do that's awesome. Do you think that there are enough people getting diabetes, self-management education? Do you think it's something that's used? 

AMBER: No, I think it's underutilized. I mean there's been some studies 

SARAH: ...underutilized. 

AMBER: I think there's studies that have shown that people don't go to it for whatever reason or they aren't getting referred to it for whatever reason. I know even our own needs assessment almost 10 years ago now. Showed that a lot of the people that were interviewed in that weren't offered a program. You know, one thing that stood out was a provider telling them that they should just avoid the white fluffy stuff. And we were like, what's the white fluffy stuff? You know, 

SARAH: What is that? 

AMBER: So like that's not very helpful. 

SARAH: Right, right. That's fantastic. So it's a program that's underutilized that really would be beneficial for creating, um, self-confidence in management, managing your condition. Getting support around you instead of people telling you what to eat. Maybe people giving you more support around the entire management of your condition. 

AMBER: Well, and you know, a lot of times one of the questions that gets asked too is by a spouse or an adult child that's, you know, supporting their parent or you know, a child that, you know their parents in the remote, can I wanna come, I wanna learn from this too. They always do welcome families to be a part of it. You know, when you have multiple people in the house engaged and helping, it's easier. 

SARAH: Absolutely. I think so too. 'cause usually it's the household that, someone is serving the meals in that household. So what does that look like? I think that's fantastic. Alright. I think that's wonderful. Do you think that the results are worth it? Like you think that patients who have been to D-S-M-E-S that when they come back, do you think that there is a change? Do you think there's an improvement in those patients? 

AMBER: Absolutely. They'll come back and like I'll ask how did diabetes education go? Yeah. When was it? And they'll like, I learned this and this was so helpful and you know, this educator was such a great resource. And their numbers have improved and they are more in target or at goal than they were before they went. So I think there's definitely benefits to be had from it. And you know that when targets are being met, progression of complications and development of complications also decreases. 

SARAH: Yeah. That's fantastic. I think one more thing we should talk about too, just so everyone is aware of how many classes there are that are included in a diabetes self-management education program and support program. So I think that's oftentimes overlooked. I think people think it's a one and done, but how many, how many classes are usually offered? Or what does, what does that program usually look like? 

AMBER: It can vary, but the okay. With, from my experience with the program over the last decade plus, yeah. Uh, there have been four sessions. You know, at one time we were doing four sessions. They were about an hour a piece. Okay. And then over time, uh, due to being mindful of the time, this can take for some people because people are busy. 

SARAH: Yeah, Absolutely. 

AMBER: Um, they, there've been, uh, some offerings of three sessions instead of four. 

SARAH: Okay. So sometimes multiple. So expect multiple sessions. It's not just gonna be a one and done. Which makes sense. 'cause there's a lot to cover when you think about self-care Yeah. In diabetes. So I think that's fantastic. Is there anything else you'd like to add about diabetes management, self education?

AMBER: I think it's great and it's important because when you think about it, when somebody gains a diagnosis of diabetes, you're looking at potentially 180 extra self-care behaviors in a day. And you know, that's a lot.

SARAH: That's a lot. 

AMBER: In addition to everything else that you do. So having someone to help provide support and the coping strategies and that extra, you know... 

SARAH: ...Direction or confidence, whatever it is that you need 

AMBER: Yeah. That those extra... help with that. You know, aspect of things I think is super important. 

SARAH: I think that's fantastic. Alright. I think that's, I really do think, um, the QI is working on diabetes, self-management, education and support, something we are working on, um, for this wave. And I think it's an important thing for our provider just to understand as well. So I really appreciate you coming and talking about it and I'm hoping it gives our, our providers and our patients some support and encouragement to do that program. So thank you so much Dr. Healy. It's always a pleasure.
 
AMBER: Nice to be back.
 
SARAH: Thank you so much.