Anastasia Albanese-O'Neill, PhD, APRN, CDE
Clinical Assistant Professor
Director of Diabetes Education and Clinic Operations
University of Florida, Division of Endocrinology
Why did you choose to become a diabetes care and education specialist?
In many ways, this profession chose me. Fourteen years ago, I was driving my 5-year-old daughter to school. During the ride, we were talking about our weekend plans —participation in the JDRF Walk to Cure Diabetes. As we turned into the school parking lot, my daughter (who by then had been living with diabetes for 4 years) asked, “Mom, what are you doing to cure diabetes?”
After she got out of the car, I stayed in the parking lot for a while, carefully considering her question. It was soon thereafter that I decided to return to school and become a nurse, then a diabetes care and education specialist, then a nurse practitioner, and finally earn my PhD.
As a nurse practitioner and certified diabetes educator in pediatric diabetes clinic at UF Health, how do you find your job structure unique?
I love my job because it combines patient care, education, technology and partnership with children with diabetes and their families. As an NP and diabetes care and education specialist, I have the right (and I think perfect) credentials and training. I have long believed that emerging diabetes technologies have the potential to improve patient outcomes while simultaneously reducing burden and improving quality of life. To be sure this happens, people using diabetes technology need information and training to optimize their experience and get the most out of the devices they use.
As a nurse practitioner and diabetes specialist, I have the training to see them all the way through this process. When I talk with a child and their family in my clinic, I can help them decide which technology is best. I have the certifications to train them on how to use various devices (CGM, pump, hybrid closed-loop, etc.). I can then review data with the family and make adjustments to insulin doses or pump settings. Because I work in an academic research setting where we conduct clinical trials on emerging technologies, I can also invite patients to participate in studies where they get to test new devices and help us optimize new systems. Each day is exciting and rewarding.
You have the unique perspective of working in two different industries, healthcare and the airline industry, each with a focus on safety. Can you share how you’ve translated your safety work/perspective from the airline industry to patient safety in your current role and if/how that has elevated your practice?
The airline industry is one of the most heavily regulated industries in the world. You literally cannot push a plane back from the gate in the United States without permission from the federal government (air traffic control). And safety, in both the airline industry and healthcare, is paramount.
I am fortunate that I had the privilege of working at Southwest Airlines under its founder, Herb Kelleher, who built the company from the ground up and created a culture that celebrated the people of Southwest Airlines – both its employees and its customers – as part of an extended family. Herb led by example, and taught us to take our jobs seriously, but not ourselves. He encouraged us to always lean toward the customer; safety was first, but once safety was assured, he preferred that we provide “outrageous customer service” and sometimes that meant begging for forgiveness rather than asking for permission. Now that I work in healthcare, I have tried to carry these lessons forward. I think of my patients as part of my extended family. I work hard with our team to build systems that ensure their safety and I also try to get to know each child and family as individuals with unique needs. Once safety is assured, I work to make sure the bureaucracy of healthcare doesn’t interfere with patient care. This forces me, in partnership with my team, to constantly examine our systems. Are they effective? Are they helping us provide the best care? Maintaining safety? Achieving the best outcomes? Optimizing the patient experience? If not, then we work to change our processes to reach these goals.
Diabetes-related technology serves as the foundation for your practice. How did you go about creating this culture, and what has been the subsequent impact on those you serve? How were you able to implement a process where CGM is prescribed at diagnosis?
The process of integrating continuous glucose monitors (CGM) into our clinical model was a combination of good timing, planning, passion and luck. First, CGM have improved radically over the past 5 years; they are smaller, more accurate, and have tremendous benefits like non-adjunctive indications (no finger pricks), share technology, and the ability to review data and the ambulatory glucose profile in an app on a smartphone. In addition, we have evidence that people with diabetes who use CGM have better glycemic outcomes. So, in no small measure, I was the beneficiary of good timing. I also report to a division chief (Michael Haller, MD) and work in a culture at UF Health that is forward thinking and patient focused. We saw the potential benefits for our patients and dedicated ourselves to implementing a CGM training process in our clinic. It was slow at first. We had to build the systems from scratch, including a referral process, templates in the electronic health record, clinic flow, and billing. In the first couple of years, we didn’t always get paid. Not everyone was completely on board, but we won them over! Everyone in our division sees the benefit of CGM and dread clinic visits when we only have BG data to review. Taking that next step to prescribe CGM at or immediately following diagnoses was a logical next step and embraced by our patients. Moving forward, we need to make sure every patient who could benefit from CGM has access.
You’ve completed research on the role of technology in type 1 diabetes management and education and are a prior recipient of AADE’s Innovation in Media & Technology Award. Can you speak to the importance of technology in the role of the diabetes care and education specialist today?
I like diabetes devices, but I LOVE diabetes education. It is the foundation for success in diabetes management and, in my opinion, often underappreciated and definitely underfunded.
Editorializing aside, we need to think broadly about technology in care. In addition to glucose monitoring and insulin delivery device technology, there are data sharing apps, decision support algorithms, online education, optimization of the electronic health record, and much, much more. Diabetes care and education specialists can become experts in all or one of these areas, and in that capacity, make a significant and essential contribution to the diabetes care team and the patient experience. Every clinical team needs a “go to” technology expert. We should seriously consider filling that role.
You have been a strong advocate for diabetes management in the school setting, including speaking at congressional hearings, writing guidelines, and serving as co-chair for the American Diabetes Association’s Safe at School Working Group. What issues do you consider to be most critical to providing quality diabetes management and education in our nation’s schools?
Children with diabetes spend about a third of their day at school. It is essential that diabetes is managed effectively at school if children hope to meet glycemic targets and be happy, healthy, and productive students. There are three key issues:
- School nurses and staff need to be knowledgeable about diabetes care and they need to be familiar with current and emerging diabetes technologies. Given the number of new technologies just in the last 5 years – CGM share technology, artificial pancreas systems, Bluetooth pens – it’s hard for school nurses and staff to keep up. Diabetes care and education specialists can play a central role in educating school staff and keeping them up to date.
- The school, family, and diabetes care team need to work in partnership. We are currently exploring novel models of care, including the use of telehealth, to improve communication and reduce misperceptions. Getting everyone on the same page at the start of the school year and moving forward together as a team every step of the way sets the stage for success.
- Leveraging technology to communicate with and train school staff is essential, particularly in rural communities. If care and education specialists can’t train the school in person, they can do it virtually by video conference!
How can diabetes care and education specialists provide care for people with diabetes where and when they need it, with the resources they need, in a culturally appropriate format?
Diabetes education and care specialists can lead when they embrace, introduce, and lead novel clinical paradigms, such as telehealth, to expand access to diabetes education and support. We can also be leaders in providing culturally appropriate education tailored to their patient population.
How has being an AADE member helped you treat patients?
I love attending the AADE conference every year because there is tremendous energy in a room filled with diabetes care and education specialists. I come away from that event energized and inspired. The organization has linked me to like-minded colleagues with whom I can collaborate with on projects, and resources like danatech.org help maintain my technology knowledge base.
What are some of your interests outside of diabetes education?
My family! And travel. And photography.
Based on your experience, what advice would you give to aspiring Diabetes Care and Education Specialists?
- Become an expert in technology – you will be well positioned to contribute to improvements in patient care and outcomes!
- Use your voice! Sometimes it can be hard to find your voice on a clinical team when everyone has so many intimidating credentials behind their name. Be confident. Be an advocate. Lead!
- Find a mentor. Your mentor could be a physician, nurse practitioner, PA, diabetes care and education specialist, nurse, dietitian, psychologist – you name it! But you need a mentor!
- Join AADE!