By Sacha Uelmen, RDN, CDCES, ADCES Director of Diabetes Education and Prevention Programs
Published in the October 2022 issue of The Science of Diabetes Self-Management and Care journal is the latest ADCES National Practice Survey, short for Current and Emerging Trends in Diabetes Care and Education: 2021 National Practice and Workforce Survey. The survey was conducted in the spring of 2021, which was just about one year into the pandemic.
As a reminder, this survey is our periodic look at the state of the profession and always has lots of great takeaways. Here are mine and some from our very impressive writing team:
Mine: While the pandemic caused significant interruptions across health care, preventive services like diabetes education and prevention programs were faced with more challenges than ever before, but also more opportunities. For instance, less than one year into the Covid-19 pandemic, over half of our respondents were using telehealth and getting reimbursed for it! Additionally, 75% of survey respondents are the “go-to” resource for diabetes-related technology or devices in their practice setting.
Diabetes care and education specialists (DCES) are definitely resilient and adaptive, but the survey identified a distinct opportunity to build awareness of our impact on financial and cost savings associated with DSMES across healthcare settings. The ADCES “Showcase Your Value” Toolkit can help you think through ways to do this.
Monica DiNardo, PhD, APRN, CDCES: Addressing behavioral health is an important aspect of person-centered care. Ninety-five percent of survey respondents identified healthy coping as a key DCES area of influence. However, there is limited research regarding practical approaches that address modifiable risk factors associated with diabetes-related distress and mood disorders. Based on survey findings, ADCES aims to continue to encourage and implement new evidence-based resources, assessments, and training tools that target diabetes distress, depression, and other mental health conditions to guide practice and strengthen self-care behavioral processes and outcomes.
Dawn Noe, RDN, LD, CDCES: A big takeaway for me was that we are now interacting with patients virtually and there is so much opportunity to serve people with diabetes and provide diabetes care and education in new ways. In 2021, 7 in 10 respondents reported they were interacting with patients virtually compared to 1 in 10 reported in 2017. And, while 41% of respondents recommend online communities to patients, less than 5% reported connecting directly with patients on a social media platform (Facebook, Twitter, or Instagram). I see tremendous opportunities to reach people with diabetes online especially as most of the day-to-day care and living with diabetes happens outside of the healthcare clinic.
Barb Kocurek, PharmD, BCPS, CDCES: Workforce challenges exist across all practice settings and disciplines. Most of the time is spent on direct patient care or documentation with little time to advocate or communicate the value of their services. In addition, there is a lack of staff and leadership support to provide preventive services which contribute to the rising prevalence of diabetes. This supports our need to widely communicate the value of our services to decision-makers in all practice settings!
Donna Ryan, MPH, RN, RDN, CDCES: Key findings indicate an ongoing evolution of scope and impact of the DCES in both practice and in the health care ecosystem. As health care has rapidly evolved over the last few years, DCES are demonstrating a broader scope, focusing on diabetes prevention and improving quality of care, expanding into diverse practice settings and care delivery models, embracing diabetes community care coordinators, and providing collaborative care and care delivery that includes cardiometabolic and specialty care, medication therapy, and technology-enabled care.
As Sacha already referenced, survey results indicate that DCESs are influential in diabetes care decisions and key aspects of care. These include therapeutics such as medication management, insulin initiation and titration, and access to medications. DCESs influence the modality and delivery of care through telehealth integration and community collaboration and peer support. As technology experts, DCES are emerging as the most well-trained healthcare professional in diabetes-related technology.
DCESs provide integrative and collaborative care across care settings. They provide direct services, collaborate with providers and team members, and initiate referrals as needed. Care settings and services include practicing in cardiometabolic service lines such as obesity prevention and treatment, kidney management, cardiac rehab, and cardiovascular risk reduction programs.
Andrew, PharmD, BCPS, CDCES: Diversification is an underlying theme tying together many of the findings identified from NPS21. ADCES has done a significant amount of work focused on Diversity, Equity, and Inclusion, and these findings show us there is still work to be done! We know that our DCES workforce needs to be representative of the people we serve – and we continue to see this is not always the case. In addition to recruiting more non-White individuals into the specialty, we also need to find more ways to diversify in other areas including gender (5% of respondents are male) and age (70% of respondents are 45 years of age or older). The latter is especially important for continuing to develop the specialty’s pipeline and ensure sustainability for people with diabetes in the future.
In addition to diversifying our people, our services are also seeing substantial diversification – with just under half of respondents providing the traditional DSMES model (DSMT) and slight increases in other models focused on population health/risk stratification, chronic care, or both. DCES are also diversifying their knowledge base on diabetes technology. Although barriers still exist in practice to fully implement many of these technologies into everyday clinical practice (e.g. hybrid closed loops, smart pens, digital health), over half of respondents are very familiar with each of these topics (even if not currently using in practice). This suggests a majority of the workforce is ready to educate on these tools as their adoption by patients and payers increases rapidly.
Michael See, MS, CEP, CDCES: The 2021 National Practice Survey (NPS21) comes at a seminal time in history for the prevention and management of diabetes. This complex, insidious disease with a constellation of complications and co-morbidities will only be addressed through patient-centered care, advances in technology, and the implementation of innovative models of care.
Diabetes care and education specialists (DCES) are critical in this period of transition. They represent diverse disciplines with the ability and desire to adapt and acquire additional skills and knowledge. In the coming years the challenge will be to bring new members into the care team (Diabetes Community Care Coordinators) as well as the next generation of professionals more reflective of the at-risk population. Additionally, as members of the care team, DCES will need to develop innovative models of care delivery that achieve favorable measurable outcomes and are financially sustainable.
Sacha: Diversifying our profession is going to be essential to meet the growing number of people with diabetes. Diabetes care and education specialists love their jobs (about 90% reported being very satisfied or somewhat satisfied in their position), so spread the word about this rewarding career path. Let the cat out of the bag: share, mentor, sponsor, promote and take action today to grow our profession to meet the growing need! Read the 2021 National Practice Survey in full.