Well-known educator and author Hope Warshaw, MMSc, RD, CDE, discusses a variety of issues including the under utilization of diabetes educators today, the importance of taking early action with prediabetes, and overcoming the challenges of eating restaurant meals.

By John Parkinson, DiabetesCare.net Clinical Content Coordinator

Whether consulting with Fortune 500 corporations, doing speaking engagements, or writing books on subjects such as diabetes meal planning and healthy restaurant eating, Hope Warshaw (pictured) brings an entrepreneurial spirit to her practice. In addition, Warshaw has just joined the Board of Directors of the American Association Diabetes Educators (AADE).

The concept of team approach can be defined as healthcare providers collaborating in a patient’s clinical care. In theory, this might include a primary healthcare provider, needed specialists, and diabetes educators working together. However, Warshaw questions how much of the team approach is applied in the real world of medical practices where there’s rarely a diabetes educator on staff.

Hopefully, as diabetes educators develop programs on site at primary care practices and the patient centered medical home model gains ground and acceptance, diabetes educators will have greater access to people with metabolic syndrome/prediabetes and diabetes who are in need of education and support. And, perhaps most important, diabetes educators will continue to demonstrate they can bend the cost curve, as AADE has demonstrated - see the AADE’s journal, The Diabetes Educator.

Her varied business experience, involvement with the AADE, and large network of colleagues makes her someone who provides an important voice in the diabetes education arena.

DiabetesCare.net discussed these issues with Warshaw and here are some highlights from the conversation:

DiabetesCare.net: Despite the obvious need, there is also a feeling by some diabetes educators that they may be underutilized by persons with diabetes (PWD) due to both healthcare providers and peoples’ unawareness about our existence, eligibility options and reimbursement for diabetes self management training. As a group of health care providers, do you think diabetes educators need to do a better job of communicating this point to other medical professionals and PWD?

Warshaw: From what we know, PWD type 2 mainly see primary care providers for their diabetes care. Of these, there are not many of these providers who bring in diabetes educators to counsel patients. Hopefully, many actions on many fronts will create change in this area, and in years, help PWD live healthier and feel better supported.

DiabetesCare.net: Taking a multi-professional team approach where primary care providers, CDEs, and social workers are involved in a patient’s care is a practice model being looked at, but maybe not utilized as much as it could be. How can CDEs work with primary care providers more effectively for the betterment of patients?

Warshaw: This notion of ‘your diabetes team’ is not really a reality today. When you consider that only 40 percent of people with diabetes ever even meet with a diabetes educator once, we have a long way to go before we achieve greater access and utilization to PWD who could benefit from education and support.

DiabetesCare.net: You have written extensively about healthy restaurant eating, do you think more people with diabetes struggle with portion control or is it more of an ingredient problem, like not knowing the secret carbs in their meals?

Warshaw: People with diabetes are people and they have challenges with restaurant eating just like anyone who tries to eat healthier. When PWD eat restaurant foods/meals, I believe they struggle with assessing the carbohydrate content of foods (for those who use carb counting), portion control, and I think there are challenges with sodium as well. We, as healthcare providers, greatly underestimate just how challenging it is to guestimate the carb counts of foods in general and it’s particularly difficult with restaurant foods.

DiabeteCare.net: For a PWD is getting a handle on daily carb counting the single most important element to their glucose control?

Warshaw: I really don’t like to give one answer for a population of millions who vary in their needs, wants, desires, and motivations. For many people with early onset prediabetes or type 2 diabetes, a top priority for them is getting their portion sizes under control…simply eating less (other than fruits and vegetables). And, I think it is really important to look for indicators like the research in the Diabetes Prevention Program (the major clinical trial) and the Look AHEAD study to see that from a nutrition standpoint the nutrition management focus was first calories and then fat grams. There was not a focus on carb consumption. There was, however, a focus on frequent follow up and support. In reality, I believe it is that latter that helped the behavioral counselors in these studies achieve pretty big results.

DiabetesCare.net: The CDC’s recent announcement of the number of PWD , people with prediabetes, and the well known statistics on the overweight and obesity rates, reinforces the need for action now. How would you characterize what the country is doing in terms of addressing the problem of obesity?

Warshaw: From research, like the Diabetes Prevention Program and other diabetes prevention studies, the messages that must get out to the public are: 1) prevent weight gain (or any further weight gain); and 2) a small amount of weight loss (5-7 percent from starting weight) achieved through control of calories and fat grams along with 150 minutes of exercise per week, can prevent or delay the onset of type 2 diabetes.

What people need to understand is that the development of type 2 diabetes is about a decade in the making. It starts with metabolic syndrome and if not addressed proceeds to prediabetes and then to type 2 diabetes. What we know is that the earlier in this course that the weight loss and physical activity is implemented, the more impact it can have on disease prevention or delay.

Healthcare providers and educators will want to stay tuned to the efforts of the CDC’s Division of Diabetes Translation. Much is happening in this area. Hopefully, CDC’s lead will encourage health plans and Medicare to promote programs which aid and support people’s efforts at preventing type 2 diabetes. We’ve simply got to get ahead of this curve.

To find out more about Warshaw’s books and other professional educational services she offers, go to her site: www.hopewarshaw.com.

Originally posted by DiabetesCare.net on May 6, 2011.