AADE e-Advocacy Newsletter
October 2009


By: Walter M. Bortz, II, MD

Some of the happiest and saddest moments of my full life are the days when I volunteer in one of the nearby community free clinics. This commitment gives me pleasure, as I may be filling an otherwise unfilled need. My down days trouble me by the content of my experiences.

A typical patient is a rotund thirty-five-year-old Hispanic mother with four overweight kids. She has come in for one purpose, and that is to receive free drug samples for her Type 2 diabetes. She even brings in a shopping bag in anticipation of filling it with outdated pills that happen to be in the supply closet.

Predictably, her hemoglobin A1C levels are terrible despite or because of the pills. I say because of the pills because she, like millions exactly like her, defaults her care to a drug with no attention whatsoever to physical activity or diet. In my view, her future is full of dark omens; as is that of her kids—seeing her accumulated neglect.

As I do a brief inventory of her knowledge about her disease, ignorance abounds. And of course language barriers make such communication even more difficult. Effectively, her diabetes IQ is barely detectable. Sadly, in her view I and the clinic am in charge of her sugar levels. And she recognizes no personal responsibility.

I mention this fact of life to illustrate my major cause right now, which is health illiteracy. In my view health illiteracy is the ultimate cause of more deaths than all the traditional major villains of heart disease, cancer and stroke combined. Such a pervasive ignorance underlies the neglect or contempt for self-care. The chic term for this psychological condition is “abandonment of the locus of control.”

In general, there is a universal public assumption that the medical profession is in charge of the collective well-being, and thereby able to mobilize a magic bullet to shoot whenever difficulties present. This is a forlorn and fatal miscasting. Virtually all the big killers are incurable. You never cure a heart attack or stroke, or rarely diabetes; we palliate. After the fall, Humpty Dumpty is never whole again, despite 2.7 trillion dollars each year in the effort.

Probably the best use of my time at the clinic would be to spend an hour or more with each patient with the intent of establishing a curriculum to understand the disease adequately, gradually building up knowledge. I would guess that maybe a five or six hour crash course might be a start, but even that modest investment in my and my patient’s time is not to be. And that is sad.

Enter the CDE—Certified Diabetes Educator. My admiration, respect, and commitment to the CDE are deeply felt. Some of you may recall that I dedicated my book, Diabetes Danger, to Certified Diabetes Educators because I feel that within their job description, philosophy and practice lies our best hope for addressing the diabetes epidemic.

The American Association of Diabetes Educators list 15,000 CDEs across the country. Roughly one per hundred medical doctors and one per 20,000 population. The principal reason behind this small supply is, guess what? Money!

The CDE’s pay is perhaps one quarter that of a physician. A survey of physicians’ incomes by Modern Physician magazine records that the average internist makes about $180,000 per year. The AADE reports that the CDE’s average pay is $65,000 per year. On average, she is 51 years of age and has spent 25 years in the healthcare arena—11 in diabetes specifically. Most hold college degrees; one third hold advanced degrees.

Several reports indicate that the involvement of the CDE results in a marked improvement in diabetes care—hemoglobin A1C levels are better. The inescapable result is an improvement in health care expenses, so that the cost-benefit relationship is clear.

The general issues surrounding the CDE’s role in disease prevention and management is very much a miniaturized version of what we are facing in the healthcare system in general in America. Professor Clayton Christiansen of the Harvard Business School asserts that one of the critical problems confronting our troubled profession is what he terms “overshoot.” He principally illustrates this with the abundance or superabundance of specialists and who care for conditions for which a far less polished professional would serve adequately. He feels that such an overshoot is a major characteristic of our bloated system—using a sledgehammer when a fly swatter would suffice.

For me, this strikes close to home. My medical training in general, and in diabetes in particular, has been exquisite—college, residency, fellowship, research, etc. I am really very overqualified for what I encounter in the community clinic. One of my favorite sayings is that of Sydney Brenner. His words: “You can’t know everything. You don’t need to know everything. Just enough.” How much is enough when caring for the average of our tens of millions of diabetics overflowing the system?

What is needed in the clinic is not me, but three or four CDEs. They will spend more time, communicate better, relate better and have better outcomes.

All of this takes a stronger focus on the floor of the House of Representatives in Washington as House Bill HR-2425 is debated. This is intended to provide provider status to the CDE. In the big picture the cost savings will be immense. I have lobbied my local representative and Speaker of the House Nancy Pelosi in support of this bill. I encourage any and all of you to push any buttons that you might have to push for the support and approval of HR-2425.

As a sports enthusiast, I’m always caught up in the hoopla connected with the choice of the MVP. I have cheered Joe Montana for example. But when it comes down to the MVP of diabetes my choice would not go to the doctor or even the endocrinologist, to the ICU, nor the dietitian, the exercise trainer, or to the pharmacy… particularly not to the pharmacy. My vote enthusiastically goes to the CDE as the MVP. It even sounds right—CDE … MVP, CDE…MVP.

Let’s hear it!


*If you would like to receive the Diabetes Wellness News please contact our subscription department at 1-866-293-3155 or diabeteswellness@diabeteswellness.net for more info. We are happy to send you a sample issue.


(JACKSON, Miss.) – The Mississippi Department of Environmental Quality (MDEQ) and the Diabetes Foundation of Mississippi Wednesday announced a new initiative to more safely dispose of medical sharps or needles. The Household Medical Sharps Disposal Program includes the establishment of more than 90 voluntary community sharps collection stations, located primarily at retail pharmacies and at municipal fire stations, that will accept sharps collected by home users in puncture-proof, sealed containers. The sharps collected at these stations will then be picked up by waste disposal companies at no charge to the collection stations.

In the State of Mississippi, there are an estimated 90,000 individuals that give themselves more than 30 million injections each year as self-treatment for numerous health problems, the most prominent of which is diabetes. The most common means for disposing of these syringes is to throw them into the household trash or to flush them down the toilet. This creates a hazard for needle stick injuries to occur among garbage collection workers, wastewater treatment employees, janitorial workers, and the general public.

“We are excited to be part of this unique program and appreciate the leadership of the State Senator Tommy Moffatt and the Mississippi Legislature who passed the Home-Generated Medical Sharps Disposal Act in 2008. It’s rewarding to find solutions to problems and even more rewarding to work with the Diabetes Foundation of Mississippi, pharmacists, fire chiefs, and private businesses who saw a need and worked together for fellow Mississippians.

“With the launch of this program, home users are provided with a no-cost alternative for safely disposing of their sharps, waste collection and disposal businesses employees are assured of a safer work environment, pharmacies are providing greater service to their customers, and the public is provided with a safer environment. In addition, the many fire departments that have volunteered have nothing to gain from the program, but they are providing a great public service,” said MDEQ Executive Director Trudy Fisher.

“The Diabetes Foundation is pleased to be a part of this much needed initiative for Mississippi with the Mississippi Department of Environmental Quality. The scope of the project in providing a safe and effective way to dispose of needles and lancets for people with diabetes and others who require daily medication via injection will protect many sanitation workers and the general public," stated Mary Fortune, Executive Vice President of the Diabetes Foundation.

One of the key components of this new program is the establishment of more than 90 voluntary community sharps collection stations throughout the state. These stations, located primarily at retail pharmacies and at municipal fire stations, will accept sharps collected by home users when brought to the stations in puncture-proof, sealed containers. The sharps will then be picked up by waste disposal companies at no charge to the collection stations. Most of these sharps will be gathered and disposed of by several companies currently collecting and disposing of medical wastes in the state – Enserve South Central, Inc. based in Canton, CleanEarth, Inc., of Hattiesburg, DisposeALL, Inc., of Brookhaven, as well as other medical waste service providers in the state.

MDEQ is also promoting another option for managing sharps in the home through the use of a simple device known as a needle clip which clips the metal needle from the syringe. The potentially injurious needle is encapsulated in the clip and the remaining part of the disposable syringe may then be safely disposed in the household trash or taken to a community collection station. Becton, Dickinson and Company has donated 3,000 of their clips for use in Mississippi.

Participating in the initiative are:

  • TheDiabetes Foundation of Mississippi
  • The Mississippi Fire Chiefs Association
  • The Mississippi Association for Home Care
  • The Mississippi Pharmacists Association
  • The Mississippi Independent Pharmacist Association
  • CleanEarth, Inc.
  • DisposeALL, Inc.
  • EnServ South Central, Inc.
  • Becton, Dickinson and Company
  • The Mississippi State Department of Health.

More information is available at: http://www.deq.state.ms.us/medsharps.



There are nearly 24 million people in the United States who have diabetes. Yet most people don't yet understand what living with diabetes is like, what the are the symptoms of diabetes and what can be done to prevent type 2 diabetes.

Visit the World Diabetes Day USA petition and pledge to do three things to make World Diabetes Day a success in the USA this coming Nov. 14, 2009. You can get ideas of things you can do at www.WDDUSA.org.



Become a fan of AADE on FACEBOOK, follow us on TWITTER or make connections on LinkedIN! 


If you are interested in health care policy, consider applying to become a Health Policy Fellow.

Offered by the Robert Wood Johnson Foundation, this Health Policy Fellows Program is an outstanding opportunity for exceptional midcareer health professionals and behavioral and social scientists with an interest in health and health care policy. Fellows experience and participate in the policy process at the federal level and use that leadership experience to improve health, health care and health policy.

For more information and to apply, click here.

Take Action: Include DSMT in the Health Care Reform Package!
Contact Your Senators and House Member of Congress

Dear American Association of Diabetes Educators members, friends, partners and supporters,

Over the past few months you have received a number of messages from AADE asking that you to take action on issues by contacting your Senators and House Member of Congress. These messages may seem redundant but understand that every grassroots alert has a purpose and that is to address varying-relevant issues as they arise in both the House and Senate. Also, know that these messages will continue to change as the bills progress through the House and Senate.

We are very excited that the CDE provision has been added into the current Senate Finance Committee Health Care Reform bill as well as the House version of the bill (H.R. 3200). This is by no means an assurance that the final bill that comes to the floor (for the House or Senate) for vote will still have the CDE provision intact.

Now, more than ever, it is crucial that we increase the overall number of demonstrated supporters of this provision as well as increase the overall number of demonstrated supporters (cosponsors) to H.R. 2425. This will help add strength to AADE's lobbying efforts in Washington to keep this provision in the final Health Care Reform bill, as we will show the depth of House Member interest on our issue.

We ask that you contact your Senators and House Member of Congress and request that they support the addition of the CDE provision into the both versions of healthcare proposal and give the millions living with diabetes access to quality DSMT! When you are done, pass this info on to your friends, family and peer and encourage them to call their Senators and ask the same.

We have also seen that there is much debate over Healthcare as a whole. As we have said in the past, it is important to keep in mind that our focus on this critical piece of legislation is all about increasing access to DSMT and designating all Certified Diabetes Educators (CDEs) as recognized Medicare providers for this invaluable service. And again, the key is to keep our efforts focused on DSMT and not on the upside or downside of the proposal as a whole.

Take Action!

For more info please contact AADE's Advocacy Specialist, James Specker at advocacy@aadenet.org

ADVOCACY TIP OF THE MONTH: Navigate the Policy and Advocacy Web Pages!

AADE's Policy and Advocacy page offers a number of resources to help members and its supporters with their legislative efforts.

In this section of the AADE website you can:

  • Learn more about AADE's stance on legislative and regulatory issues.
  • Take action on legislation pending before Congress.
  • Find your State and Federal Legislators.
  • Get help communicating the facts of DSMT with your members of Congress.
  • Find valuable resources for your State and Federal Advocacy efforts.
  • Stay abreast of changes in the legislative arena, as well as get advice on legislative issues at the state and federal level that affect diabetes education and diabetes educators.

In an attempt to make the process of navigating the Policy and Advocacy section of the AADE webiste easier we have created an easy to follow aid to show you how.

To access the PDF please click here.