With more than 18 million Americans diagnosed with diabetes, another 5.2 million undiagnosed diabetics, and some 40 million classified as "pre-diabetic," it's clear that the need exists for diabetes education. Diabetes is a leading cause of blindness, kidney failure, amputations and heart disease that claims 180,000 U.S. lives a year.
In 1996, the southern New Jersey-based Kennedy Health System opened its first diabetes education center, Diabetes Control, at its Family Health Center location in Somerdale, Camden County. The program - originally opened and operated with the support of Eli Lilly, a national pharmaceutical corporation - proved popular with patients and referring physicians alike, and 3 years later a second site opened in Washington Township, NJ.
Kennedy has been able to keep both programs alive and well, despite a serious regional downturn in the operation of such programs. Since September 2000, 15 diabetes education programs in Pennsylvania have closed - four of them in Philadelphia, according to the American Diabetes Association. While there are no hard and firm reasons for such closures, it's apparent that financial constraints and issues regarding reimbursement play a role.
Kennedy's two Diabetes Control Centers are staffed by certified diabetes educators, two of whom are registered nurses and two are registered dietitians. Carol Skinner, RN, CDE, worked for many years as an ICU nurse before her then-husband, and later her daughter, were diagnosed with type 1 diabetes. She became a CDE more than 10 years ago because of her growing interest in diabetes education and has been based at Kennedy's Washington Township Diabetes Center site since its 1998 opening.
Monika Black, RN, CDE, had tried her hand at all types of nursing care, from ED nursing to home health, before turning her focus to diabetes education.
"I saw so many patients who had medical complications related to diabetes," Black recalls. "It was frustrating. I knew there had to be a way I could make more of a direct impact."
Kennedy's Diabetes Control program offers a comprehensive plan that includes three group classes, running three hours each, along with two follow-up encounters over a 6-month period. Patients can self-refer, but most are sent to the center by their primary care doctor - either shortly after their diabetes diagnosis or because of escalating health issues related to the disease.
"Sometimes they come in crying and saying, 'I don't understand why I'm here,'" Skinner recalls. "Those are the ones where it takes some time to break through their barriers. With diabetes, there's often some denial going on."
All patients in the Kennedy Diabetes Control program undergo a full assessment to determine their level of knowledge about the disease and to ascertain any special needs or goals they may have. Depending on a patient's needs, he will either receive one-on-one counseling or take the comprehensive classes.
The classroom curriculum is tailored to the adult learner and includes many interactive activities and practical information that can be put to use in day-to-day life. Classes are kept small - no more than 10 people per class - and actual class times are flexible. Participants are allowed to invite a family member to attend their training sessions. Each patient - whether he is being counseled individually or in a group - receives an individualized meal plan created by a Kennedy dietitian.
"We encourage family members to play an active part in this," Skinner says. "They can make a real difference in supporting and encouraging their loved one, and helping that person make smart nutritional choices."
A study of more than 800 people enrolled in the comprehensive program at Kennedy determined that, after 6 months, the average patient's blood sugar levels had improved by 15 percent. The study also showed a drop in hospitalization and ED visits related to their diabetes.
"It does make you proud to realize that you've done something that can make a real and lasting difference," Black says.
The demographics of participants in the diabetes program are diverse. The average age is 58 and slightly more than half are female. Nearly seven out of 10 participants are Caucasian, with African-Americans making up the next largest ethnic group at 19 percent. Almost all have type 2, or adult onset diabetes, although the centers also see women with gestational diabetes and patients with type 1 diabetes. In 2003, 1,344 people took part in classes offered through the two Kennedy diabetes centers.
Diabetes is a disease with many facets. Therefore, the classes offered at the center cover a wide variety of topics, including: understanding diabetes, how to choose and use a glucose meter, nutrition, exercise, medications, family support, stress management and managing long-term complications.
"It's amazing how quickly the participants start to connect," Skinner says. "By the third class, they're showing each other family pictures and sharing recipes."
Two years ago, in an effort to ensure the future of the diabetes education program, Kennedy decided to consolidate the diabetes centers by placing them within the existing Family Health Centers. By saving on operational overhead and combining nonessential staff functions, Kennedy has been able to keep the two sites viable.
"We decided at the inception of the program that we would do whatever we could to offer diabetes education to the public in this type of a supportive setting," says Kennedy president and CEO Richard E. Murray. "We've hired top-notch nurses and diabetes educators; and I think their fine work and ability to address the needs of a diverse patient population have helped build a strong word-of-mouth reputation for diabetes control at Kennedy and have been the reasons for its continued growth."
Encourage Better Health
Skinner and Black do what they can to keep the program in the forefront of people's minds, promoting it via health fairs, community wellness lectures and through direct contact with referring physicians.
But often it is program "graduates" who prove to be the best marketing tool.
"Often, someone who has been through the program will tell a friend or a relative," says Skinner. "It can be very reassuring and encouraging for a person with diabetes to see how well someone has done through our educational programs."
Patients who have completed the program are reassessed through one-on-one meetings at one-month and 6-month intervals. Topics covered during the follow-up encounters include blood sugar monitoring, diet and exercise, family support issues and long-term goals.
Goal-setting, Skinner says, is a key component of the program. Each participant sets his own goals as the classes or counseling sessions progress. These goals generally involve following a meal plan, increasing exercise level and avoiding medical complications of the disease.
"Because our participants set their own goals, they tend to be compliant," Skinner says. "They have to live up to their own expectations."
Program participant Eileen Murphy, 62, says she has learned more through Kennedy's Diabetes Control program than she ever anticipated. Diagnosed 10 years ago with type 2 diabetes, Murphy wanted to learn how to manage her disease better. "I really hadn't been watching my diet and I wasn't sure what I should be doing - but I knew I needed to be doing some things differently," she says.
"I learned so much about nutrition and medications and medical complications," she shares. "I would recommend this to anyone with diabetes. It was informative and interesting."
For both Skinner and Black, working with diabetic patients has proven challenging and deeply rewarding. "It's great to know you can make a lasting impact on someone's life and future," Skinner says.
"When patients come back to thank you for helping them get their diabetes under control, it's a wonderful feeling," adds Black.
Nicole Pensiero is corporate director of communications for the Kennedy Health System, headquartered in Voorhees, NJ.