Saturday Session Details

Concurrent Breakout Sessions 8:30 am – 10:00 am

S02
Hyperglycemia in the Hospital: Fact & Fiction

Mamie Jane Lausch, MS, BSN, RN, RD, CDE
Manager, Core Content
International Diabetes Center (IDC), St. Louis Park, MN

Nykole L. Starks, Associate, RN
Research Clinician
International Diabetes Center (IDC), St. Louis Park, MN

This session is meant to help the diabetes educator who works in an inpatient or an outpatient setting learn the issues surrounding hyperglycemia in the hospital. Transition of patient care from inpatient to outpatient setting requires specific interventions to assure the patient does not get lost in the healthcare system. Optimal glycemic management is a team effort and requires system processes of which the diabetes educator can play a pivotal role. This presentation offers specific examples of how to help initiate this change.

UPN: 069-000-09-194-L01-P

Back to Overview  

S03
Perioperative Glycemic Management in Acute Care

Carol Manchester, MSN, ACNS, BC-ADM, CDE
University of Minnesota Medical Center, Fairview
Minneapolis, MN

Nationwide, questions related to the perioperative management of known patients with diabetes and stress induced hyperglycemia continue to be asked. Diabetes educators, advanced practitioners, and health care providers are being called upon to develop guidelines for preoperative instructions, intraoperative protocols and postoperative glycemic management. Yet, there is still much disagreement in the scientific community regarding “best practice”. This presentation will provide the latest research findings, standards and guidelines for practice, and useful strategies for the acute care professional.

UPN: 069-000-09-227-L01-P

Back to Overview

S04
At Your Fingertips: Web-Based Diabetes Education


Elizabeth L. Quintana, EdD, RD/LD, CDE
Clinical Associate, Nutrition Program Coordinator
West Virginia University School of Medicine, Morgantown, WV

Computer technology has become an integral part of health education. Diabetes educators can benefit from Internet tools. Participants will become familiar with factors that make a website a quality source of diabetes information. Keeping pace with current practice guidelines and clinical research poses a challenge for the busy educator. This presentation will deliver examples of useful online diabetes resources for both the educator and patient. Interactive distance education for professional development will be also be highlighted.

UPN: 069-000-09-087-L04-P

Back to Overview

S05
Continuous Glucose Monitoring: Translating Information

Jennifer Martin Block, RN, CDE
Clinical Research Nurse
Stanford University Medical Center, Stanford, CA

This presentation will cover the use of Continuous Glucose Monitoring (CGM) technology in diabetes care. It will review the different types of CGM devices available for use and discuss the research and clinical findings that may help identify patients who may benefit from the use of this technology. Discussed will be highlights of patient education when preparing for the use of CGM, and new and innovative means of integrating CGM use into clinical practice. Case studies will be presented to help the audience to learn how to interpret the data provided by the various software programs associated with the CGM systems.

UPN: 069-000-09-140-L01-P

Back to Overview

S06
Medication Management: Fostering Adherence to Improve the Patient Experience


Gayle M. Lorenzi, BSN, RN, CDE
Community Health Project Manager
University of California San Diego, La Jolla, CA

Prescribing the most appropriate medication(s) is important to the patient’s treatment success. With prescription in hand, the individual cascade of behaviors and critical decisions begins for the patient. Multiple individual and environmental factors can lead to underutilization of prescribed medications. As patients and providers strive to achieve optimal glycemic control, complex regimens using multiple injectables are more common. In addition, staffing constraints interfere with healthcare provider efforts. This session will spotlight an innovative program of treatment options and other findings.

UPN: 069-000-09-195-L01-P

Back to Overview

S07
Health Literacy: What You Say—And What the Patient Hears!

Sarah Piper, MPH, CDE
Diabetes Education Coordinator
Diabetes Association of Atlanta, Atlanta, GA

Health literacy is the ability to read, understand and act on health information. The need for individuals, especially those living with a chronic disease like diabetes, to be health literate is greater than ever because medical care is more complex and patients are expected to carry out their own self-management. This interactive session will define the problem of health literacy in the U.S. and discuss solutions to address the gap between what a patient hears and understands from their provider or educator—and what is truly intended!

UPN: 069-000-09-101-L04-P

Back to Overview

S08
New Dimensions in the Business of Reimbursement


Peggy B. Bourgeois, MN, RN, CNS, CDE
CEO
PBB Associates LLC, Baton Rouge, LA

Jerry Meece, RPh, FACA, CDM, CDE
Director, Clinical Services
Plaza Pharmacy and Wellness Center, Gainesville, TX

Billing and reimbursement continue to be an issue for hospitals and offices/clinics across the country. In today’s diabetes practice, hospital programs are closing or developing new concepts to transition the patient from hospital to home and presenting DSMT by collaborating with private practice, family practice and pharmacies. Among the topics addressed at this session will be: developing relationships with insurance case management programs and obtaining grants and other funding to provide diabetes education for both insured and underserved populations.

UPN: 069-000-09-089-L03-P

Back to Overview

S09
Five Things Your Hospital CEO Needs to Know

Donna Butler Ryan, BS, MPH, RN, RD, CDE
Manager
Providence Holy Cross Medical Center, Mission Hills, CA

The diabetes educator has a challenging nontraditional role in the hospital that contrasts to many outpatient duties. When focusing on the hospital, the CDE also focuses on changing the 'system' to improve the care of the diabetes patient. The CDE serves as an evidence-based practitioner who uses literature and data to guide hospital policy and practice. The CDE also serves as a diabetes informatics specialist, providing crucial data to the administrators and CEO of their facility's performance on diabetes outcomes. This session provides a simple, practical approach to describing the glucose problems in the hospital, measuring and benchmarking data, and implementing quality care and treatment initiatives.

UPN: 069-999-09-066-L04-P

Back to Overview

S11
Exploring the Spiritual Dimension of Diabetes Care

Rachel H. Girard, MS, MTS, RN, CDE
Diabetes Nurse Specialist
Maine Medical Center, Portland, ME

As societal health needs continue to focus on the diabetes epidemic, health professionals must explore new ways to assist patients to "live well" with the disease. Individuals need help integrating the various aspects of their personhood (physical, psycho-social, sexual and spiritual) into an overall sense of wellness. This presentation will challenge diabetes educators to consider the concept of spirituality as integral to providing holistic, quality care.

UPN: 069-000-09-151-L04-P

Back to Overview

S12
Celiac Disease: The Digestive Tract in Flames

Carren Sellers, MMSc, RD/LD, CDE
Registered Dietitian and Diabetes Educator
Private Practice and Saint Joseph's Center for Diabetes Care, Atlanta, GA

For people with diabetes, celiac disease is a nutritional and diagnostic challenge. Treatment requires permanent elimination of gluten from the diet. Some people with celiac disease exhibit no symptoms. Those with diabetes and undiagnosed celiac disease may experience unexplained hypoglycemia and symptoms attributed to gastroparesis. Learn how to identify celiac disease, create gluten-free diets and manage glucose for the celiac impacted.

UPN: 069-000-09-065-L01-P

Back to Overview

S13
Diabetes Education & Blindness: A Mexico Case Study

Joel Rodriguez-Saldana, MD
Resultados Medicos
Desarrollo e Investigacion SC, Pachuca, Hiidalgo, Mexico

Andrea Cecilia Rosales-Campos, RD, CDE
Resultados Medicos

Laura Itzel Vazquez-Rodriguez, MD
Resultados Medicos

Carmen Rangel-Leon
Psychologist, Diabetes Educator, Resultados Medicos

Francisco Martinez-Castro, MD
Hospital Oftalmologico Nuestra Señora de la Luz AC, Mexico City

Diabetes is one of the leading causes of blindness worldwide. Leading contributing factors include deficiencies in the quality of diabetes care, scarcity and denial of diabetes educators, organizational deficiencies, scarce economic resources, and lack of interest. Starting in 2006, agreements were made to deliver diabetes education to patients seeking education at the three largest ophthalmology hospitals in Mexico City. As a requirement to receive diabetes education, each patient completed a survey to assess the quality of care previously received. The results documented serious deficiencies in the quality of diabetes care delivered at public and private institutions in Mexico.

UPN: 069-000-09-117-L04-P

Back to Overview

S14
New Dimensions in Diabetes Education

Linda B. Haas, PhC, RN, CDE
Endocrinology Clinical Nurse Specialist
VA Puget Sound HCS, Seattle Division, Seattle, WA

AADE's Professional Practice Committee (PPC) is a multidisciplinary committee that has developed, or overseen, the development of several products to enhance the practice of diabetes education and further the profession. These products include the Scope of Practice, Standards of Practice and Standards of Professional Performance for Diabetes Educators, The Continuous Quality Improvement monograph, position statements and a practice advisory. In addition, the PPC oversees and interprets AADE's biannual National Practice Survey and has overseen the recent development of the Guidelines for Practice of Diabetes Education, which defines levels of practice. This presentation will show how these products can be used to enhance the practice of individual educators and to advance the profession of diabetes education.

UPN: 069-000-09-144-L04-P

Back to Overview

S15
Everything You Wanted to Know about AADE's DEAP (Diabetes Education Accreditation Program)

Lois Moss-Barnwell, MS, RD, LDN, CDE
Director, Diabetes Education Accreditation Program
American Association of Diabetes Educators, Chicago, IL

On February 27, 2009, AADE became a CMS-approved accrediting organization for outpatient Diabetes Self-Management Education Programs. With the ever increasing numbers of patients being diagnosed with diabetes, the demand for quality diabetes education programs continues to rise. AADE is providing a DSMT accreditation option to healthcare professionals seeking to meet the needs of the diabetes population in their community.

UPN: 069-000-09-209-L04-P

Back to Overview

General Session 10:30 pm – 12:00 pm

G04
Release Your Brilliance: 4 Steps to Transforming Your Life and Revealing Your Genius


Simon T. Bailey, MBA, PhD
Founder, The Brilliance Institute, Inc.
Author, Release Your Brilliance, Simon Believes…Brilliant Service is the Bottom Line, Simon Believes…Success is an Inside Job, and Simon Says Dream: Live a Passionate Life

Internationally-known speaker, author and consultant Simon T. Bailey inspires individuals to take charge of change and transform their lives from the inside out. Fortune 500 companies, national associations, government agencies and educational institutions look to him to help release the potential in their people. Dr. Bailey’s exciting keynote session will enable participants to develop their personal brilliance and bring greater value to their work, relationships and daily activities.

UPN: 069-000-09-224-L04-P


Diabetes Self-Management Education or Training

Ian Duncan, FSA, FIA, FCIA, MAAA
President, Solucia Consulting, a SCIOinspire Company
Farmington, CT

Diabetes Self-Management Education or Training (DSME/T or DSMT) focuses on providing knowledge and information within a skills-based training and behavioral framework to reduce complications and improve quality of life outcomes. While DSME/T has been shown to improve quality of life and clinical outcomes, the impact of DSME/T on financial outcomes (cost of patient care) has not been similarly studied. The impact of DSME/T on financial and clinical measures within a large health plan dataset was also studied.

Back to Overview

Concurrent Breakout Sessions 2:00 pm – 3:30 pm

S01
The Patient-Centered Medical Home: So, What’s All the Fuss?


Richard G. Roberts, MD, JD, FAAFP, FCLM
Professor of Family Medicine
University of Wisconsin School of Medicine & Public Health, Madison, WI

A large and growing body of evidence consistently demonstrates that healthcare systems based on family medicine and primary care have betteroutcomes and lower costs than a specialist-dominant system. Despite this, interest in and the viability of primary care is declining. Data will be shared arguing for family medicine and a patient-centered medical home. The concepts of disruptive innovation and practice redesigns will also be discussed, along with their likely impact on future healthcare. The session concludes with a glimpse of healthcare 300 years in the future.

UPN: 069-000-09-226-L04-P

Back to Overview

S16
Gestational Diabetes: Do We Have a Consensus?

Diane M. Reader, BS, LD, CDE
Manager
Diabetes Professional Training International Diabetes Center, Minneapolis, MN

Sharmila Chatterjee, MSc, MS, RD, LD, CDE
Outpatient Clinical Dietitian
UCSD Medical Center, San Diego, CA

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy, affecting approximately four percent of women. GDM is associated with macrosomia, and neonatal hypoglycemia in the infant and an increased risk of cesarean section and developing type 2 diabetes within 10 years after delivery. Speakers will review evidence-based guidelines for the management of GDM, provide strategies for practice implementation, and define areas where additional research is needed.

UPN: 069-000-09-141-L01-P

Back to Overview

S17
Creating the Diabetes Lesson Plan: Blueprint to Innovation

Barb Schreiner, PhD, RN, CDE, BC-ADM
Sr. Clinical Education Specialist
Amylin Pharmaceuticals, San Diego, CA

Susan LaRue, RD, CDE
Clinical Science Specialist
Amylin Pharmaceuticals, San Diego, CA

How do you keep your content focused and relevant? Teach interactively to engage the learner? And make learning memorable? Experience the creative power of fellow participants and experienced facilitators to build diabetes lesson plans which become living, breathing, useable resources for curriculums. Guided by the AADE7™, participants will use a novel blueprint to construct lesson plans which incorporate brain-based learning theories.

UPN: 069-000-09-106-L01-P

Back to Overview

S18
Bloom! Growing Your Diabetes Program in Not-So-Fertile Soil

Jennifer Foster, RN, CDE
Coordinator
Diabetes Education, Christus Santa Rosa Hospital, New Braunfels, TX

As the number of individuals with diabetes and prediabetes steadily increases, so does the need for diabetes education and management programs. Yet in these difficult economic times, many programs are downsizing or closing. Improve your program's sustainability, the number of clients you are able to serve or perk up your existing sessions. One suburban program not only increased their revenue over 100% in one year but increased the number of clients served, improved the level of care delivered, and improved their participants' satisfaction and ability to make lifestyle changes to enable them to live successfully with diabetes.

UPN: 069-000-09-197-L03-P

Back to Overview

S19
The Role of Dietary Fructose in Obesity

Karmeen Kulkarni, MS in Nutrition, RD, CD, BC-ADM, CDE
Director
Scientific Affairs Abbott Diabetes Care, Salt Lake City, UT

The consumption of fructose, primarily from high-fructose corn syrup (HFCS), has increased considerably in the United States during the past several decades. Intake of HFCS may now exceed that of the other major calorie sweetener, sucrose. Fructose could have potentially harmful effects on other aspects of metabolism. The rise in non–alcoholic fatty liver disease (NAFLD) parallels the increase in obesity and diabetes. There are hypotheses that increased fructose intake can result in NAFLD. This session will discuss the role of fructose in obesity and hepatic disease, if any.

UPN: 069-000-09-139-L04-P

Back to Overview

S20
Adherence to Diabetes Performance Measures in Ambulatory Care Settings

Michele P. Holskey, MSN, RN, CDE
Clinical Nurse Specialist
Carilion Health System, Roanoke, VA

Diabetes has been singled out as a disease whose management often reflects poor quality and needs improvement. This intensive adherence study describes the quality of diabetes care in an ambulatory practice setting using measures of performance taken from the National Diabetes Quality Improvement Alliance and the ADA Clinical Practice Guidelines. The sample was generated through an electronic query of 69,000 patients with diabetes. Patient characteristics (age, gender, ethnicity, insurance type) were explored in addition to the process of care measures (testing and frequency of HbA1c, lipid profile, blood pressure, urinalysis for microalbuminuria) as well as associated clinical health outcomes.

UPN: 069-000-09-198-L01-P

Back to Overview

S21
Inflammatory Effects of Foods and Chemicals

Gita Patel, MS, RD, CDE, LD
Nutrition Consultant for Feeding Health, Etna, NH

Jan Patenaude, RD, CLT
Carbondale, CO

Non-IgE mediated adverse food reactions can be an important symptom provoking a component of diabetes and co-morbid symptoms of diabetes. They are a common cause of many chronic conditions and affect an estimated 15-20 percent of the general population. Identify the foods and chemicals triggering inflammation and learn how dietary changes specific to the individual and clients can reap benefits!

UPN: 069-000-09-199-L04-P

Back to Overview

S22
The Potential (and Pitfalls) of Evidence-Based Diabetes Practice

Diana Sherifali, PhD, RN, CDE
Professor
McMaster University, Hamilton, Ontario

Evidence-based practice (EBP) has been used in diabetes management and plays a crucial part of everyday practice, especially when updating knowledge and evaluating outcomes. However, the fundamentals of EBP have changed over the years, resulting in misconceptions, frustration and a backlash towards EBP. The purpose of this presentation is to review the concepts of EBP and discuss how this may be implemented successfully into everyday practice. This presentation will review research paradigms, discuss the concepts of best evidence, and outline and use examples of EBP as they relate to diabetes education and management.

UPN: 069-000-09-103-L04-P

Back to Overview

S24
Diabetes and Cancer: Management of "Special Cases"

Veronica Brady, RN, BSN, MSN, FNP-c, CDE
Family Nurse Practitioner
UT MD Anderson Cancer Center, Houston, TX

Diabetes affects nearly 23 million Americans—eight percent of the population. Yet six million of these people are not aware that they have the disease. In 2007, diabetes was the seventh leading cause of death in the United States. In 2002, the National Cancer Institute estimated that there are more than 10.1 million Americans with a history of cancer, and about 1.4 million new cases of cancer were expected to be diagnosed in 2006. As incidences of both diabetes and cancer arise, the number of cancer patients with diabetes will increase as well. Preliminary research involving cancer patients with diabetes has revealed that treatment of hyperglycemia/diabetes may result in better cancer outcomes.

UPN: 069-000-09-080-L01-P

Back to Overview

S25
Call Center Services for Diabetes Education

Diana Karczmarczyk, MPH
Associate Manager, Training & Development
American Diabetes Association, Alexandria, VA

Learn why over 300,000 diabetes patients contact the American Diabetes Association's National Call Center every year. Discover why they call, the educational gaps that exist for them, and the benefits of utilizing call centers as a reliable health education tool.

UPN: 069-000-09-124-L04-P

Back to Overview

S26
Fighting Diabetes with Physical Activity

Donna L. Wolf, PhD, ACSM-ES
Research Director-Exercise Physiologist
University of Pittsburgh Diabetes Institute, Pittsburgh, PA

Physical activity has been shown to be an important health-related behavior. Physical inactivity is a behavior that is likely to be long-standing. Therefore, physical activity is a behavior that requires change or modification. Although the benefits of exercise and physical activity are known, population trends show that a large percentage of adults and children are not physically active at a level that will allow for these health benefits. Diabetes educators have to understand the principles of physical activity behavior change and educate patients to adopt a regular and consistent activity programs.

UPN: 069-000-09-114-L01-P

Back to Overview

S27
Supporting Lifestyle Changes Through Support Groups

Linda S. Watson
Diabetes Social Worker
WellStar Health System, Marietta, GA

Active group ownership of a support group is a balance between autonomy and maintaining professional leadership. Many support group participants find it preferable to leave leadership and education to the experts. Because of this, the individual's considerable knowledge and experience regarding diabetes self-management are too often hidden from the rest of the group. This interactive presentation will explore the role of the professional facilitator, focusing on ways of tapping into the leadership skills and creative problem solving within the group itself.

UPN: 069-000-09-071-L04-P

Back to Overview

S28
Web Technology & Diabetes Education for Asian Americans, Pacific Islanders


June Y. Kim, MPH
Program Coordinator
Association of Asian Pacific Community Health Organizations, Oakland, CA

With the support of numerous partners, such as the NDEP AAPI Workgroup, the Association of Asian Pacific Community Health Organizations (AAPCHO) has created the Health Information Gateway: a tool that makes available online a range of high-quality, Asian American, Native Hawaiian and Pacific Islander (AAPI)-related diabetes education materials for a mass audience. The site is also a community capacity-building tool that enables AAPCHO to raise the standards of AAPI health education materials by employing the expertise found within the AAPI community.

UPN: 069-000-09-072-L04-P

Back to Overview

S29
The Role of Sleep in the Management of Type 2 Diabetes


Eileen R. Chasens, DSN, RN
University of Pittsburgh, Pittsburgh, PA

There is compelling evidence that sleep disorders, obesity and impaired glucose metabolism not only co-exist but also frequently exacerbate each other. The current epidemic of obesity is a risk factor for both obstructive sleep apnea and type 2 diabetes. This presentation will review normal sleep and factors such as increased age, circadian rhythm, medications and sleep disorders that can modify sleep—and impact diabetes for both better or worse.

UPN: 069-000-09-081-L01-P

Back to Overview

S30
Research Presentations: Behavior Change


Must attend all sessions (a,b,c) to receive credit.

Back to Overview

S30a
Research Presentations: Behavior Change
Why WAIT?- Multidisciplinary Program for Weight Control in Obese Patient with Diabetes- 1 Year Later


Amanda Kirpitch
Nutrition Educator
Joslin Diabetes Center, Boston, MA

Research Hypothesis, Purpose, or Objective: To Our goal was to facilitate modest, sustainable weight loss and improvement in a number of other health parameters in a population of obese patients with diabetes using a structured, multi-disciplinary 12-week weight management program.

Study/Design Methods: 85 participants with mean age (54.2 ±1.2 years), diabetes duration (9.8 ±1.1 years), weight (235.3 ±4.6 pounds), BMI (38.4 ± .6 kg/m2), and waist (46.7 ± .6 inches) were enrolled in the 12-week program and have been followed for an additional year. Patients followed a structured, modified dietary intervention based on the Joslin Nutrition Guidelines with a macronutrient distribution of 40% carbohydrates, 30% protein, and 30% fat. This included a meal replacement for breakfast and lunch during the first 10 weeks of the program. Structured dinner menus were provided. The patients transitioned to breakfast and lunch menus by the end of the program. All participants engaged in an individualized, graded, and balanced exercise plan that was demonstrated in 1-hour weekly sessions and transitioned to their home workout routines. Patients also received cognitive behavioral intervention throughout the program provided by a clinical psychologist.

Results: After 12 weeks, average weight decreased by 24.6 pounds (10.3%) and at one year 55 percent have maintained weight loss or continued to lose weight. Average weight loss at one year was 18.2 pounds (7.3% of initial weight). Body composition improved with a 40.2% decrease in body fat (p<.001) and a 1.8% (p<.05) decrease in their lean/fat ratio. Glycemic control improved with A1C drop from 7.5%-6.6% at 12-weeks. At 1 year, A1C was 7% in the participants that continued to lose weight and increased to 7.8% in those that regained weight. Total Cholesterol and LDL-cholesterol decreased 10.8% and 9.6% respectively (p<.01). Triglycerides also decreased by 18.2% (p<.001). Urinary albumin/creatinine ratio decreased at 1 year from 29.4 mcg/mg to 25 mcg/mg (p<.01). Inflammatory markers improved with an increase in Adiponectin from 6.7 µg/mL to 11.6 µg/mL (p<.01) and a decrease in TNF-a from 3.99 pg/mL to 2.96 pg/mL (p<.05) at months. C-reactive protein was also decreased from 6.1 mg/L to 4.4 mg/L at one year compared to baseline (p<.01). These results were achieved along with a decrease in medication resulting in a cost savings of approximately $560 per pt per year.

Conclusions: A 12 week weight multidisciplinary weight management program is successful in reducing not only weight, but improving diabetes control, and other health parameters in obese patients with diabetes.

UPN: 069-000-09-170-L01-P

Back to Overview

S30b
Research Presentations: Behavior Change
Motivational Interviewing Training: Addressing Health Behavior Changes in Metabolic Syndrome


Jan Kavookjian
Assistant Professor
Auburn University Harrison School of Pharmacy, Auburn, AL

Research Hypothesis, Purpose, or Objective: Health care providers are in a unique position to influence patient health behaviors. Patients with diabetes and metabolic syndrome face particularly complex behavior changes in that they are required to make changes on many behaviors at one time, including the lifestyle challenges of diet and physical activity. Research suggests that many providers lack the communication skills needed to help patients decide to make a lasting change. Motivational interviewing (MI) is a skill set designed to help a patient find his/her internal motivation to change and has been shown to improve behavior change and patient outcomes across many types of behaviors. A 2 1/2 day MI training program based on adult learning theory has been developed and delivered to health care providers working with patients with any or all of the diseases of metabolic syndrome. The purpose of this study was to evaluate and report 1) the learning outcomes of training participants in this training and 2) the self-reported outcomes of the patients with whom they have applied the MI skills they learned in the training program.

Study/Design Methods: Five MI training programs were offered at Auburn University in 2007/2008. The programs were attended by 189 nurse case managers, pharmacists, social workers, psychologists, physicians, and others, many of whom were certified diabetes educators. The 2 1/2 day program was designed to give participants the opportunity to develop both the cognitive and applied aspects of MI skills development through active training exercises that started out in groups with facilitated discussion, and progressed to individual exercises and role playing with feedback, and ended with two Objective Structured Clinical Exam (OSCE) cases with standardized patients. The primary objective of this progressive strategy was to help participants build confidence in their abilities to use the MI skills and to learn from each other. After the programs participants were added to a discussion list serve where they could post challenging patient cases and give each other feedback about how to respond using MI. Participants were assessed before and after each training for self-report of confidence, understanding, competence, and overall performance for using the MI skills. Four months after the fifth program, an online survey was sent to all participants, asking similar questions, but also including questions about MI use and patient impact since the training.

Results: Average achievement scores on the two OSCEs were 86.46% and 84.03%. Mean program pre and post tests score for understanding of MI concepts were pre: 2.56 (+/- 0.98)and post: 4.14 (+/- 0.58). For confidence, mean pre test score was 2.36 (+/- 1.08) and post was 3.90 (+/- 0.77); for competence, pre scores were 2.12 (+/- 0.96) and post were 3.39 (+/- .73). In addition, participants rated themselves as proficient at the MI skills of expressing empathy, supporting self-efficacy, and avoiding argumentation and needing more work for rolling with resistance and developing discrepancy. Survey: 114 of 189 responded. Participants were 87% female, 61% nurses (29% pharmacists, 10% other), ~47.9 years old, practiced for ~22.7 years, and at current setting for ~7.4 years, were more effective after the MI training (86% self-rated at 4 or 5), are now using MI skills with 63.36% of their patients, estimate that 68.67% of their patients have better outcomes because of MI use, including improved medication adherence, smoking cessation efforts, weight loss (60 lbs for 1, nearly 100 for 2 more), better blood sugars, blood sugar monitoring, starting exercise regimens, decreased blood pressure, cost savings, decrease in unnecessary ER visits, retaining more patients in case management program.

Conclusions: MI training based on a progression of adult learning theory-based exercises may help build provider confidence and effectiveness in communicating with patients about health behavior change, particularly in relation to the complicated behavior changes necessary for diseases of the metabolic syndrome. There are limitations to the study, and given the descriptive design no causal inferences can be made.

UPN: 069-000-09-170-L01-P

Back to Overview

S30c
Research Presentations: Behavior Change
Integrative Health Coaching Improves Medication Adherence & HbA1c in Patients with Type II Diabetes


Ruth Q. Wolever
Assistant Professor
Duke University, Durham, NC

Mark Dreusicke
Medical Student
Duke University, Durham, NC

Research Hypothesis, Purpose, or Objective: Integrative Health Coaching (IHC) may be particularly useful for patients with type II diabetes given the myriad behavior changes they need to make and sustain for optimal health. This innovative approach may provide a unique way for patients to improve medication adherence, better understand their barriers to change and empower them to make both behavior and psychosocial changes. Hypothesis 1: IHC will improve medication adherence and HbA1c. Hypothesis 2: The ASK-20 Questionnaire will facilitate IHC by targeting barriers to medication adherence. Hypothesis 3: IHC will facilitate behavior change. Hypothesis 4: IHC will increase psychosocial functioning.

Study/Design Methods: Integrative Health Coaching (IHC) may offer an innovative way to address the estimated 90% of patients with diabetes who do not adhere to their treatment plans. IHC is a unique collaborative process distinct from health education. In IHC, the patient considers both their physical and mental health, i.e., personal growth and healthy coping as well as healthy lifestyle behaviors. The patients themselves set the agenda by assessing their health risks and readiness to change, setting their own health goals and choosing action steps to accomplish their individual goals. Medication adherence, healthy eating, physical activity, stress management, and coping skills are all discussed; however, emphasis is not placed on advising or educating. Instead the health coach explores the patient's own agenda with curiosity, intuition and open-ended questions. Design: As part of a larger study, 48 participants [age=53.2(8.31), 23% male, 56% African-American, 44% with a college degree] were offered 14 individual telephonic IHC sessions of 20-30 minutes over six months. At a pre-coaching (baseline) and post-coaching (six months later) visit, participants were evaluated for HbA1c and a number of behavioral and psychosocial issues. Self-reported questionnaires measured medication adherence, barriers to adherence, patient activation, exercise behavior, perceived stress, mood and social support.

Results: Participants with baseline HbA1c greater than 7.0 (n=29) demonstrated a significant HbA1c reduction of 0.6 [9.0(1.75) to 8.4(1.74), p=0.024]. For the entire group of participants (n=48), barriers to medication adherence decreased [ASK-20: 42.2(8.14) to 36.9(9.10), p=0.001] and medication adherence improved [Morisky: 6.8(1.10) to 7.2(1.06), p<0.001] as a function of the intervention. Patient activation, defined as knowledge, skills and confidence for self-management, increased [PAM: 65.5(17.32) to 77.4(18.25), p<0.001]. In addition, participants reported decreases in perceived stress [PSS-4: 5.7(3.29) to 4.4(3.05), p=0.013] and depression symptoms [Burns Mood Scale: Wilcoxon Test, p=0.002]; reductions in anxiety and anger scores were not significant. Participants noted greater social support in both tangible and intangible domains [ISEL-12: 38.0(7.84) to 41.2(7.14), p=0.001]. Physical activity increased as well. Across six months of coaching, participants with low baseline levels of physical activity (fewer than once per week) increased the reported frequency of aerobic exercise [n=27, Wilcoxon Test: p=0.006], stretching [n=32, Wilcoxon Test: p=0.004] and muscular strengthening [n=41, Wilcoxon Test: p=0.015]. Finally, patients improved their overall morale regarding having diabetes [ADS: 17.7(5.09) to 15.31(4.56), p<0.001] and were able to perceive diabetes as making more positive contributions to their lives (e.g., greater acceptance) [Benefit Finding Scale: 47.1(21.20) to 51.2(20.85), p=0.006].

Conclusions: Distinct from health education in its philosophy and practice, Integrative Health Coaching appears to be a powerful intervention to improve multiple biochemical, behavioral and psychosocial targets for patients with type II diabetes.

UPN: 069-000-09-170-L01-P

Back to Overview

Concurrent Breakout Sessions 3:45 pm – 5:15 pm

S31
Insulin Dosing Formulas from Pump-Treated Type 1 Patients

Allen King, MD, CDE
Medical Director
Diabetes Care Center, Salinas, CA

Dosing formulas provide estimates for initiating and evaluating existing insulin dosing in pump-treated patients. The Diabetes Care Center has enlarged a previous database of CGM-titrated pump-treated type 1 diabetic patients to 61 and will report the derived dosing formulas from this group. Current widely-used dosing formulas have been derived from ‘well-controlled’ (defined by HbA1c) pump-treated patients. However, HbA1c fails to reflect post-meal or overnight glucose control. Proposed changes in the dosing estimation formulas will also be discussed.

UPN: 069-000-09-138-L01-P

Back to Overview

S32
Implementing a Self-Insured Hospital Employee Diabetes Management Program


Linda F. Moore, PhD, RD, LD, CDE
Manager, Diabetes Learning Center
Tift Regional Medical Center, Tifton, GA

Wanda S. Watson, RN
Outpatient Diabetes Educator
Tift Regional Medical Center, Tifton, GA

Tift Regional Medical Center is a self-insured rural hospital employing approximately 1,500 people and located in a region with the highest prevalence of diabetes in Georgia. With approximately 30% of employees identified as having elevated blood glucose values during the 2007 annual employee health screening, an employee diabetes management program was developed to aid employees in achieving acceptable glycemic control and to control the medical cost burden to the self-insured hospital. Procedures were developed to interact with the employee primary care physician to aid in achieving glycemic control.

UPN: 069-000-09-064-L04-P

Back to Overview

S34
The FTC's Initiatives to Address Childhood Obesity

Mark K. Engle
Associate Director for Advertising Practices
Federal Trade Commission, Washington, DC

The presentation will describe the Federal Trade Commission’s efforts to urge the food industry and its media partners to improve the nutritional profile of foods marketed to children and to change the way those foods are marketed. The presentation will describe the legal landscape surrounding government regulation of food marketing to children, and will report on the results of public workshops and studies the FTC has conducted, including the FTC’s landmark 2008 study that reported on both how much industry spends marketing food to children and the myriad ways it markets to children. The presentation will also discuss the efforts of the Congressionally mandated interagency working group consisting of the FTC, FDA, CDC, and USDA, to develop nutrition standards for food marketing to children. Finally, the presentation will describe the FTC’s efforts to address marketing scams targeted to consumers seeking to lose weight or to control their diabetes.

UPN: 069-000-09-228-L04-P

Back to Overview

S35
Web-Based Telemonitoring for DM & HTN with Multi-Ethnic Populations

Patricia J. Linekin, RN, MSN, CDE
Diabetes Clinical Nurse Specialist
PDS Health / Private Practice, Glendale, NY

Richard Arena, RPh, PHD, CDE, CDM
Assistant Director Pharmacy / Assistant Prof of Clinical Pharmacy
Queens Hospital Center, Jamaica, NY

Recent studies show that the use of Web-based telemonitoring can assist the diabetes educator in promoting glycemic control. Diabetes complication prevention includes hypertension control, BG monitors and BP monitors connect to the telemonitor and transmit the test results directly to the caregiver’s website. They can then communicate with the patient via e-mail or phone based on the data received. All can be a powerful patient motivator. Strategies will address the adaptations required to effectively utilize web-based telemonitoring for glycemic and hypertension control and self-management education. The multi-ethnic population base includes patients from Bangladesh, Pakistan, Haiti, Guyana as well as African American and Hispanic patients.

UPN: 069-000-09-118-L04-P

Back to Overview

S36
Serving the Underserved with Diabetes


Julie A. Wells, MSW, LCSW, CDE
Diabetes Resource Coordinator
East Alabama Medical Center, Opelika, AL

Patricia I. Block, RN, MSN, RN, CNS, CDE, ACNS, BC
Diabetes Resource Coordinator
East Alabama Medical Center, Opelika, AL

Many Americans live in poverty and Alabama is one of the poorest states. This presentation will explore the culture of poverty and identify methods to assist poor clients with chronic health needs. Discussion will include the processes and outcomes from a successful diabetes indigent care program at the East Alabama Medical Center. The program, which started in 2000, provides education, transportation assistance and blood glucose monitoring supplies to the medically underserved population in five Alabama counties.

UPN: 069-000-09-131-L04-P

Back to Overview

S38
Improving Inpatient Glycemic Control: How to Eliminate Sliding Scale

Deb Sage, BSN, RN, CDE
Spectrum Health, Grand Rapids, MI

The shift from sliding scale to basal/bolus insulin order sets is a major institutional change that affects the work flow of many departments hospital-wide. Using change management theories and tools, the attendee will learn how Spectrum Health Hospital systematically set the stage for deliberate and controlled changes that resulted in improved inpatient glycemic control.

UPN: 069-000-09-200-L01-P

Back to Overview

S39
Dilemmas in Diabetes Nutrition Therapy


Marion J. Franz, MS, RD, LD, CDE
Consultant
Nutrition Concepts by Franz, Inc., Minneapolis, MN

It is often said that nutrition therapy never works, so just prescribe medications. Weight loss is assumed to be the answer to all problems—but when is it effective, and if it isn't, why not? The glycemic index has been proposed as the answer as to what to eat. Carbohydrates are assumed to cause insulin resistance. Low carbohydrate diets are really the answer as to what to eat. Patients often report being too busy to participate in physical activities. These—and other nutrition dilemmas faced by diabetes educators—will be addressed at this provocative session.

UPN: 069-000-09-123-L01-P

Back to Overview

S40
Creating An Environment to Promote Normoglycemia in Hospital Patients

Joan Alford, BS, RD, LD, CDE
Registered Dietitian
Medical Center of Central Georgia, Macon, GA

Julie Deese, BSN, RN, CDE
Diabetes Clinical Specialist
Medical Center of Central Georgia, Macon, GA

Regina Kerbo, BSN, RN
Diabetes Clinical Specialist
Medical Center of Central Georgia, Macon, GA

Kim A. Sinclair, MSN, RN, CDE
Diabetes Clinical Specialist
Medical Center of Central Georgia, Macon, GA

Juanita R. Smith, BSN, RN, CDE
Diabetes Clinical Specialist
Medical Center of Central Georgia, Macon, GA

The development of a multidisciplinary 'Glucose Management Team' in a large tertiary care facility has resulted in the development of tools for achieving normoglycemia in all hospitalized patients. A frank panel discussion of the successes and pitfalls encountered will be presented by diabetes educators who made significant contributions to this process. Tools such as order sets, protocols, an IV insulin management system with 'downtime' procedures, and the transition to carbohydrate counting will be also be addressed.

UPN: 069-000-09-077-L01-P

Back to Overview

S41
Vitamin D: Does the Sun Still Shine on Diabetes?


Marti Reiser, MSN, RN, CNP, CNS, CCRN, CDE
Nurse Practitioner/Clinical Nurse Specialist
Emh Regional Healthcare System, Lorain, OH

Vitamin D is important across the lifespan in the treatment and prevention of disease. Learn how the vitamin can be a co-morbidity with diabetes.

UPN: 069-000-09-092-L01-P

Back to Overview

S42
Providing Diabetes Self-Management Training in Rural Clinics


Leisa Blanchard, RN, BSN, CDE, CPT
Director of Diabetes Education
Barton County Memorial Hospital, Lamar, MO

Eden Ogden, BSN, RN
Nurse Educator
Barton County Memorial Hospital, Lamar, MO

Successful diabetes self-management training does not have to be provided in traditional settings. Many clients do not have insurance to provide DSMT services. Educators can collaborate with physicians and clinics to provide education at what are traditionally diabetes wellness visits at the clinic. Barton County Memorial Hospital's format includes a presentation to the group, reviewing or formulating a meal plan by the dietitian, medication review and lab reviews, foot exams, goal setting by the nurse educators, and a wellness exam provided by the doctor or nurse practitioner. Data presented will show outcomes that prove the group visit is an effective form of education to the uninsured and underinsured.

UPN: 069-000-09-201-L01-P

Back to Overview

S43
Clinic-Sponsored Diabetes Camps: A New Dimension in Education


Lisa M. Broerman, MSSA, LISW
Social Worker
Akron Children's Hospital, Akron, OH

Amy K. Albrecht, RN, MSN, CNP
Pediatric Nurse Practitioner
Akron Children's Hospital, Akron, OH

Education is a key component in diabetes management. While the vast majority of education takes place in the clinic setting, it can be difficult for families to apply this education to everyday living. Akron's Children's Hospital decided to create a camp solely for patients and staff it with the exact team that cares for them in clinic. This way they could continue to reinforce the methods of diabetes management in real-life situations. Diabetes educators played a prominent role in the camp experience and they were able to capitalize on teaching opportunities presented throughout the week. This model offers an option for diabetes education.

UPN: 069-000-09-128-L01-P

Back to Overview

S44
Using Coaches to Support Self-Management in the Inner City


Veronica J. Richardson, MBA, RN, FCHCEM
Director
Quality Improvement, Grace Hill Neighborhood Health Centers, St. Louis, MO

Judy Jamison, RN
Myrtle Hillard Davis Comprehensive Health Centers, St. Louis, MO

The Missouri Foundation for Health funded the Better Self-Management of Diabetes program to demonstrate innovative ways for people living with diabetes to improve their quality of life through improved self management. Grace Hill Neighborhood Health Centers, Inc., and Myrtle Hilliard Davis Comprehensive Health Centers have utilized two different models using healthcare coaches in the urban community primary health care setting for the past decade. One site describes how the use of multicultural coaches addressed the needs of their new immigrant population through the use of holistic care classes. The other focuses on the multiple services provided by coaches and how these activities are integrated into the delivery system.

UPN: 069-000-09-110-L04-P

Back to Overview

S45
Smart Educational Partnering With "School Nurse Connect"


Gwen A. Davis, RN, MN, CDE
State Coordinator of Diabetes Education
South Carolina Dept. of Health and Environmental Control, Columbia, SC

Sarah J. Butler, MSN, RN, CDE, NCSN
Diabetes Education Director
National Association of School Nurses, Silver Spring, MD

This innovative model expands the role of the diabetes educator to assure competency care for children with diabetes in the schools. The South Carolina "School Nurse Connect" program began with the collaboration of the state school nurse consultant and the state diabetes and disparities consultant. Further collaboration with the National Association of School Nurses resulted in a comprehensive diabetes needs assessment tool, 15 educational modules and plans to establish a web-based continuing education program. In only six months, 111 school nurses in 12 counties have completed diabetes care needs assessment and 67 have begun education sessions.

UPN: 069-000-09-079-L01-P

Back to Overview