Michelle Litchman, PhD, FNP-BC, FAANP
Assistant Professor, University of Utah College of Nursing,
Adjunct Assistant Professor, University of Utah School of Medicine
Family Nurse Practitioner, Utah Diabetes and Endocrinology Center
Why did you choose to become a diabetes educator?
My nursing career has done a 180 in the last 18 years. Prior to diabetes, my focus was forensic nursing (child abuse, evidence collection for sexual assaults). I went into the nurse practitioner (N.P.) program thinking I would continue down the forensic nursing path. However, during my N.P. program, I happened to be in a wheel-thrown pottery class with an endocrinologist who invited me to rotate with him and his team. That rotation transformed the way I thought about diabetes, and ultimately resulted in a career shift. During that rotation I realized that I had fallen victim to focusing on the negative aspects of diabetes as a registered nurse working in the hospital setting. But as a N.P. student, I saw how hard people were working towards being healthy. Following graduation, I set my mind to accepting a position only in a diabetes specialty-clinic and was successful. As a N.P. and diabetes educator, I appreciate really getting to know my patients with diabetes. Together, we celebrate successes, work through struggles, and ultimately team up to support health.
Tell us about your work experience in the field of diabetes education.
I have had the opportunity to work in an endocrinology and primary care practice, always providing diabetes specialty care. I have been fortunate to work with practices that allowed for innovative diabetes care delivery models. In 2006 I developed a N.P.-led diabetes-specialty house call program that provided services for older adults and adults with cognitive challenges who had difficulty getting to the clinic. That program allowed me to become an expert in community resources. I was also able to train multiple home health nurses on diabetes technology, resulting in older adults maintaining or starting new insulin pumps or continuous glucose monitors. I have also provided shared medical visits. Currently, I am the medical director of the University of Utah Diabetes One-Day Education and Care Program. In one day, people with diabetes (PWD) receive interdisciplinary education and care from a nurse practitioner, certified diabetes educator, pharmacist, vascular technician, ophthalmology technician, chef, social worker, and endocrinologist in group and individual sessions. We realize that diabetes is managed in a social context. Because of this, family and friends are encouraged to attend.
At what point in your career did you decide you wanted to do research?
After I had worked as a N.P. for a couple of years I wanted to research the impact of the house program I had developed. I needed additional skills to do this, and therefore sought out a Ph.D. During my schooling, I developed the Diabetes Mixer, a peer support program for young adults with type 1 diabetes. In doing so, I met several individuals who were engaging in online peer support. The stories they told were fascinating and inspired me to switch my dissertation project to focus on diabetes online peer support communities. I graduated with my Ph.D. in Nursing at the University of Utah in 2015.
How do you combine your research and clinical efforts?
I like to research what I call “clinical reality.” Diabetes innovation and treatment options are fast-moving. Personally, I feel that I have been able to stay connected with clinical reality because I still work clinically.
You are known for your research interests in diabetes education and how it the impacts the Peer Support Community. How are your findings important to diabetes educators and to the peer support community?
Historically, healthcare providers have been hesitant about online resources due to concerns of misinformation. My research, and the research of others, has identified that diabetes online peer communities, with an emphasis on community (which is different from random web searches), self-police misinformation. In addition, online peer support users methodically processed information to determine if it is relevant and credible to their situation. Moreover, there is preliminary evidence indicating that high engagement in diabetes online peer support communities is associated with A1C levels <7%, higher levels of diabetes self-care, and higher levels of health-related quality of life. This research suggests that it is better to refer someone to a community of people, rather than random exploration in a search engine. There are documented benefits to online peer support communities. There are various types of support provided by online peer support communities addresses the “S” (support) in DSMES. Not everyone has the offline support they need to successfully manage diabetes. Online peer support may be able to help fill that gap.
What is the most rewarding aspect of your job?
Being a connector. Connecting people to resources, from home health to online peer support communities. Connecting small groups of PWD through the Diabetes One-Day Education and Care Program. Connecting large groups of PWD together through offline programs, such as the Diabetes Mixer. And connecting people (both healthcare professionals and PWD) to online peer support evidence.
What do you see as the biggest challenge facing diabetes educators today?
Access. Diabetes educators are facing challenges related to PWD not being able to access the care, supplies and medication they need. If patients don’t have coverage for a diabetes education visit, they likely won’t go. If there is coverage, there are usually limitations on how many diabetes education visits will be covered. Often it takes more than a couple of visits to adequately help PWD be successful in managing diabetes, yet for many, there is not a system in place to support this need. If PWD are not able to afford the items needed to provide self-care, diabetes educators can find themselves focusing on identifying resources rather than providing direct care.
How has being an AADE member helped you advanced your research and treat patients?
I recently led a team that conducted a scoping review. We screened over 14 thousand articles to identify 47 articles that focused on diabetes online peer support. AADE provided support to develop the search strategy. This scoping review was submitted for publication. From a clinical perspective, I have appreciated the online peer support materials that I can share with PWD and the ability to access DANA to reference diabetes technology.
Describe your best experience at AADE.
I was very excited and humbled to be able to share my clinical experience and research related to online and offline peer support at a general session at AADE18. I spoke with amazing panelists Anna Norton (CEO of Diabetes Sisters) and Elizabeth Beverly (psychologist at Ohio University), and moderator, Mary de Groot (psychologist at Indiana University). It was fascinating getting to know them and their perspectives on peer support.
What are some of your interests outside of diabetes education?
I love to make jewelry, bake, and hike. I used to pitch in college for the fast-pitch women’s softball team and love the game — so I coached my son’s baseball team this past summer. I have seven deaf family members, including my mom. I am passionate about improving healthcare experiences for people who are deaf and hard of hearing.
Based on your experience, what advice would you give to aspiring Diabetes Educators?
First, be open to learning from PWD (online or offline). Second, don’t blame, ever. Third, continually work to identify resources to support diabetes management, including encouraging family and friends to attend diabetes education visits. Finally, understand when you are not enough, sometimes a peer with diabetes is exactly what someone needs.