The Connecticut Alliance of Diabetes Educators (CADE) has steered itself through one major decision in staying independent, and its members could be facing substantial changes depending on future federal healthcare reform interpretations and the state’s pending budget for next year.

By: John Parkinson, Clinical Content Coordinator,

As CADE celebrates its 25th anniversary this month, it is in the midst of some changing and uncertain times.

While many of the regional and state CDE organizations across the U.S. have decided to join into the American Association of Diabetes Educators (AADE) national organization, CADE, practicing one of New England’s long-standing traditions of self-reliance, decided to remain independent.

This decision was not made lightly, however, and was done only after much deliberation and a vote by the membership, explains CADE Co-President Barbara Nadolny, RN, BSN, CDE (pictured, below, left). CADE’s rationale for doing so was borne more out of practical implications for CADE’s members.

CADE is also anticipating possible other changes coming from the federal healthcare reforms and possibly in Connecticut’s Medicaid budget. The state is currently planning its budget for next year and there has been talk of cuts to the state program. If this happens, it could have an undetermined ancillary effect on diabetes education in the state, which is currently a patchwork of coverage for self-management education, depending on the individual plan.

Still, CADE will continue to serve its members as it has for years, providing numerous resources and a voice for Connecticut’s diabetes educators. For example, expecting to address some internal legislative issues for its independence status, and possibly other anticipated changes in the air, CADE decided to make an organizational change going from having a single president serving a one-year term to having two people serve as co-presidents for the year. Along with Nadolny, Sandra Micalizzi APRN, CDE has been selected as co-president, and they both are serving in this capacity from July 1 of this year until June 30 of next.

Together, they oversee an organization that has between 125-150 members in a given year, and CADE remains very active, meeting six times a year. CADE is made up of mostly diabetes educators from across the state, but Nadolny says there are some members who are not healthcare providers including the Connecticut representative from the American Diabetes Association, as well as some pharmaceutical and industry company representatives. CADE also maintains a website and an online newsletter, which is published 4 times a year.

In addition to her position at CADE, Nadolny is the coordinator of diabetes education at Norwalk Hospital in Norwalk, Conn. She was recently awarded the Connecticut Diabetes Educator of the Year by her peers in CADE, and she is planning on continuing her professional development by pursuing her master’s degree in Diabetes Education and Management in the very first class being offered at Columbia University.

With so much going on, caught up with Nadolny to discuss CADE’s decision to remain as an independent organization, how it is serving its members, the possible Medicaid changes, and her hopes in pursuing her master’s degree in this new Columbia program. Both Sandra Micalizzi and you recently ascended to the co-presidency of CADE. What are your goals as co-president?

Nadolny: As it is one of transition, this is an interesting year, but I don’t expect it to be run any differently than it has in the past. However, we do have one new main goal which is to increase our membership. We want to market our organization to get more people involved and have them gain access to it. As a group, we are trying to figure out how to do that better.

Our second goal is to increase awareness to the public of the education services available across the state. We want more people—who need it--to get diabetes education. That is a consistent goal of our organization. The Connecticut Alliance of Diabetes Educators decided to not formally join with AADE. Why the decision to remain an independent organization?

Nadolny: It was decided through a membership vote. As a membership, we did review all the benefits of joining the national organization (AADE). Being in a small state like Connecticut, we have good attendance at our meetings and have a strong network of volunteer leaders already. By keeping ourselves independent, we were able to keep our funds working in a local level. People felt very strongly about that.

It is important to note, that being independent does not mean we do not support the national organization. More than 50 percent of our members are still members in national (AADE). We have the benefits of both. For an individual who wants to be a member of national, she or he can certainly do that and have the benefits associated with it. And anyone who doesn’t can still benefit from our network. What are the biggest issues you expect to face during your co-presidency?

Nadolny: With healthcare reform, legislative changes are going to happen to reimbursement. We are all concerned about that. If there are significant changes related to that, as an organization we will be looking at that. Does Connecticut’s Medicaid system offer diabetes education for state residents?

Nadolny: Connecticut state Medicaid has so many different plans, but the traditional plan does not reimburse for diabetes education. If state Medicaid is managed by certain insurance companies it may be covered, so coverage varies depending on the plan. However, it is very hard to access that information. This is a struggle for us, and diabetes educators across the nation in finding out what the coverage is going to be. When potential patients call, we try to empower them to call their insurance companies to find out more about education and coverage. The billing codes that are used for diabetes education are not as cut and dry, as say a billing code for an x-ray. It is very confusing and often people are given the wrong information about their coverage. Connecticut is in the midst of writing its budget and it is proposing Medicaid cuts. Do you expect diabetes education to be affected by this?

Nadolny: It will. In the times we are in right now, we are going to expect cuts to be affecting everything in healthcare. Currently, I can say Connecticut Medicaid sometimes covers diabetes education, but it depends on the individual plan. Most of the time there is not reimbursement. Even if there is more Medicaid cuts that probably is not going to change diabetes education reimbursement. As the coordinator for diabetes education at Norwalk Hospital, can you describe your program and what your responsibilities are?

Nadolny: Our program is recognized by the American Diabetes Association (ADA), and we offer individual and group education. We see mostly adult patients and some children. Much of my time is performing direct education and the remainder of my time is doing administrative work. I coordinate the budget and revenue cycle, and maintain all the requirements for the ADA recognition. You are also pursuing a master’s degree in the new Diabetes Education and Management program now being offered at Columbia University. Why the decision to do so? What are you hoping to achieve from it and bring back to your roles as educator and president of CADE?

Nadolny: I have always wanted to continue my professional development and pursue my master’s degree. I have always struggled to find studies specifically in diabetes education. Columbia’s program is the first offered in this topic in the country. I’m thrilled to be a part of it.

It is an online program and I’m going to be networking with diabetes educators on a national level. With the diabetes epidemic continuously growing, there needs to be more well-educated leaders and I want to be one of them.

To find out more about CADE, visit their website at .

Originally posted by on August 26, 2011.