Evan Sisson, Pharm.D., MSHA, BCACP, CDE, FAADE
Professor, Virginia Commonwealth University
Dept of Pharmacotherapy & Outcomes Science
Why did you choose to become a diabetes educator?
Part of my residency at the VA included weekly participation in an interprofessional diabetes clinic. In that clinic, I discovered the joy of helping patients solve real problems. I remember teaching a patient with low health literacy how to self-adjust his insulin. Although he had difficulty reading and writing, through repeated practice he was able to safely perform the skill. A few months later after seeing another provider in clinic, he came down the hallway with a beaming smile waving his recent A1C result, saying “I knew you would want to see this!” He was obviously proud of his accomplishment and I was glad to have helped.
At VCU, what do you find unique about your position?
Working at VCU School of Pharmacy, I am blessed with the opportunity of combining my love for patient care and diabetes education with the intellectual challenge of teaching students and sharing my experience. Not only do I get to care for patients in the clinic, but I also get to lead teams of students on several medical outreach events across the state. My colleagues at the school share my passion for helping patients and each other, which makes for a wonderful work environment.
One of your current practice sites includes an inner-city free clinic. What is your perspective on the disparities in diabetes management in vulnerable populations? How can diabetes educators have an impact?
Working with the uninsured population for the past ten years has changed my view of health disparities. Although our clinic patients do not have health insurance, most of them work up to three jobs to provide for their families. Prior to serving in this clinic, I assumed that poor health could be distilled down to just a few causes; however, I quickly learned that the barriers to good health are many and unique to the individual situation. The challenge is to take the time to build relationships and listen to the patient before offering a solution.
The two most common challenges for the uninsured population with diabetes is access to insulin and blood glucose testing. Through caring discussions with the patient, diabetes educators can determine what the patient can afford and help the provider select a treatment plan that meets the jointly approved goals of care.
Lately there has been increased focus on hyperglycemia and the use of GLP-1 Receptor Agonists (RA). What has been your experience with GLP-1? How do you view the new recommendation from the ADA 2019 Standards of Care indicating that GLP-1 be the second class of medications when metformin alone isn’t effective?
The GLP-1 RA were placed high in the 2019 ADA treatment algorithm based on their proven cardiovascular benefit that extends beyond their ability to lower glucose. Addition of GLP-1 RA to our diabetes treatment options has been a great help to the uninsured population because of the generous patient assistance programs from the pharmaceutical manufacturers. The GLP-1 RA are ideal for the uninsured population for a variety of reasons, they have: 1) high cardiovascular risk due to smoking and other comorbidities (39% of our clinic patients smoke); 2) weight management issues and obesity (our average BMI is 34 kg/m2); 3) variable meal schedules that increase the risk of hypoglycemia; 4) low incomes making expensive blood glucose testing unfeasible; and 5) poor health literacy/numeracy making prandial insulin dosing based on carbohydrate counting extremely challenging. The once weekly injectable GLP-1 RA and coming oral agents offer a significant lift for a patient population with overwhelming health burdens.
What is the most rewarding aspect of your job?
The most rewarding aspect of my job is seeing the “ah-ha” moment when a student or patient suddenly realizes that they can resolve a problem on their own. This feeling is amplified when I hear one of my students using my words to explain a concept to a patient and see the same “lightbulb” response. Many of my past students and residents have become certified diabetes educators and presented at the AADE annual meeting. One of my past residents recently even served on the AADE Board of Directors. Watching my mentees present on a national stage and seeing the exponential impact of teaching others is awesome!
What do you see as the biggest challenge facing diabetes educators today?
The greatest challenge for diabetes educators to overcome is the perception of many health executives that technology and the internet are a satisfactory replacement for personal interaction. Too often, positions for diabetes educators are being replaced by printouts from the electronic medical record. Although the internet offers a wealth of information, the heart of diabetes education comes from the relationships that educators create with their patients. Only through listening to patients can we help guide them to discover the best behavior change approach for them. Clearly, empathy and active listening is a skill that cannot be replaced by a computer or mobile app.
How has being an AADE member helped you treat patients?
The members of AADE are its most valuable asset. Every year at the AADE annual meeting, I take home a trove of new information to improve the care of our patients. At the 2018 AADE annual meeting I attended several sessions related to social determinants of health. When we returned home, we instituted a screening tool to identify food insecurity, housing issues, and symptoms of depression and anxiety. We used this information to make appropriate referrals to behavioral health and other resources within our clinic. In addition to the personal experiences and innovative ideas from fellow educators at the AADE annual meetings, I am also very fond of the tip sheets and other resources found on the AADE website that we use every day in clinic.
How has your participation on the AADE18 and AADE19 planning committees influenced your career and leadership role at AADE?
The commitment to interprofessional teams makes AADE stand out among health professional organizations. The AADE18 and AADE19 planning committees reflect this diversity which contributed to the rich conversation at the meeting. Hearing opinions from committee members across a variety of backgrounds expanded my understanding and appreciation for the breadth of innovative work to overcome the challenges facing people with diabetes. These experiences reinforced the importance of including a variety of voices when leading teams at my own institution.
What are some of your interests outside of diabetes education?
Outside of diabetes education, I enjoy cooking new recipes with my wife and playing video games with my 11-year-old twin girls.
Based on your experience, what advice would you give to aspiring diabetes educators?
For aspiring diabetes educators, I highly recommend that they find a mentor and come to the AADE annual meeting. There is a lot of work yet to be done in diabetes prevention and education that begs for innovation, creativity and passion. The great thing about AADE is the willingness of its members to selflessly mentor proteges to continue caring for our patients.