Up Close Interview: Advocating for Certified Diabetes EducatorsMonday, April 04, 2011
The new chair of the NCBDE, Samuel Abbate M.D., C.D.E., wants to encourage fellow healthcare providers to recommend CDEs more frequently to their patients and wants insurers to become more aligned with CDEs’ value in the patient equation.
By: John Parkinson, DiabetesCare.net Clinical Content Coordinator
According to the National Certification Board for Diabetes Educators’ (NCBDE) website, the organization’s mission is to recognize and advance the specialty practice of diabetes education. The NCBDE oversees the testing for the CDE credentialing, and through the end of last year, over 17,000 medical professionals have achieved their CDE accreditations, according to NCBDE’s CEO Lance Hoxie.
DiabetesCare.net had an opportunity to sit down with the NCBDE 2011 Chair recently. The new chair is Dr. Samuel Abbate, who is an endocrinologist and diabetes educator. He ascended to the NCBDE Chair in January.
Dr. Abbate (pictured) discussed many NCBDE related topics including the importance of having more physicians connecting their patients to CDEs; some of the credentialing practices; and what it is like to practice medicine in Alaska. Here are some of the highlights from the interview.
DiabetesCare.net: Can you provide us with a little bit of background about your medical practice?
Dr. Abbate: I am in a solo, private practice in Wasilla, Alaska, which up until the last [presidential] election very few people had heard of. I provide both diabetes clinical services and education as well as endocrinology services to folks in the area.
DiabetesCare.net: Do you have any separate education programs for diabetes?
Dr. Abbate: In my practice, we do have two certified diabetes educators full-time, as well as one diabetes educator dietitian, who works with us part-time. In addition, I collaborate with the local hospital and participate in their education classes which are done on a monthly basis.
DiabetesCare.net: What is it like to be practicing medicine in Alaska as opposed to the lower 48 states? Any particular geographic challenges in delivering care there?
Dr. Abbate: Yes, absolutely. We are, physically, the biggest state, but we have one of the smallest populations and that population is very broadly dispersed. From where I am, which is close to Anchorage, I have had patients as far away as Nome which is north of the Arctic Circle, all the way down to Sitka in the southeast portion of the panhandle. We have to rely on technology like faxes and e-mails and electronic communication to be in touch with patients. We often do a great deal of telephone-based education and counseling.
DiabetesCare.net: In looking at the population of Alaska, are there any special population related challenges? Are the indigenous people of Alaska at a greater risk of developing diabetes like other minorities throughout the U.S.?
Dr. Abbate: The Alaskan native population is different than the lower 48 in that they don’t seem to have dramatic, increased rates that you see among the Navajo, the Lakota, or the Sioux. Having said that, we have the challenge of having our native population living quite remotely where the access to healthier sources of food and activity are limited. For example, getting fresh vegetables here is very difficult and very expensive. You have to rely on pre-packaged things and often they are higher in salt, higher in fat. Like other places, we have struggles with obesity, and that is pushing up the numbers but they are not at the levels of native groups in the lower 48.
DiabetesCare.net: How did you first come to be involved in the NCBDE?
Dr. Abbate: I became involved in 1991, when completing my fellowship at the University of Washington. I was determined to become a certified diabetes educator. My reasons were several fold. Number one, I felt that it was important that I have a background and training in the educational process, and from my fellowship, I was certainly getting the technical side of it taken care of. Then number two, I thought it was also important as a physician to promote the value of the education and caring for persons with diabetes. I often say physicians, nurses, and dietitians don’t treat diabetes, versus diabetics treat their own diabetes. I liken it to coaching. The coach trains the players, run the drills, teach the skills, but when it comes to gametime, the coach stays on the sidelines and the players are on the field. With diabetes, people come in for critical visits, for education, but they have to go home and apply it. I thought it was important to show my colleagues my commitment to that.
DiabetesCare.net: What are going to be your primary responsibilities as the 2011 Chair for the NCBDE?
Dr. Abbate: It goes back to the core purpose of the organization, which is to increase recognition of the credential, and make sure the providers, payers, and patients know this credential is out there and how they can benefit from it. I also want to encourage more health care professionals to become CDEs. We know that they will have technical expertise in their area, but they will have a broader understanding of diabetes in the many facets to treat it. [We want to] encourage more professionals to get involved, and promote the value of the CDE to providers so that they link their patients up with CDEs to paying organizations so that they break down the barrier of education. As a physician it is frustrating that I can order an amputation or cardiac bypass with less push back from the insurance company than I can get from somebody meeting with a CDE.
DiabetesCare.net: Do you have any specific goals as Chair?
Dr. Abbate: I have several goals. Number one is launching and implementing the mentorship program. Number two is we want to address some areas we think are opportunities. For years, everybody has known who a diabetes educator is, but if you look at our website, it is hard to find a formal definition. We are charged with forging a formal definition. We are also developing a cannon of ethics, which any professional organization should have, and being an umbrella organization for all CDEs we felt it was important.
DiabetesCare.net: Can you provide an overview of NCBDE’s new diabetes educator Mentorship program?
Dr. Abbate: We are responding to a demand here. The program is meant to match those applying for the CDE with someone who is practicing as a CDE for at least three years. Mentors then work and help them [applicants] accumulate up to 400 hours of their required 1,000 hours. The beauty of this is that not only do you get up to 40% of your hours, you also get the practical experience under the guidance of someone who is certified. We have had more than 50 CDE volunteers to act as mentors.
DiabetesCare.net: Are there any other initiatives the NCBDE is planning to roll out for 2011?
Dr. Abbate: What we are trying to do as an organization is evaluate how we are communicating with our CDEs through our newsletters, website, and communication packets. This is not a static organization. The NCBDE wants to be relevant to educators in their daily practice. The people that are in diabetes education really do it out of a passion. If you didn’t have a passion, you wouldn’t work for a 1,000 hours to get this credential, so that’s a very energizing, very positive group to be involved with. That’s why we want to promote the value [of the CDE] because we really believe that education is the key to good [diabetes] management. If you look at the diabetes control and complications trial, which was the largest trial in diabetes, it was the trial that demonstrated that tight control mattered and resulted in diminished complications and better quality of life for patients.
DiabetesCare.net: If there are any changes to CDE testing or requirements, how does the NCBDE decide upon that and what is the process of adopting the changes?
Dr. Abbate: We have two standing committees, the credentials committee and the exam committee. The exam committee [performs] a very dynamic process. The organization really invests in this exam. People are invited onto the committee, and the organization goes out of its way to train people in the skill of writing exam questions. The questions are vetted for not only content accuracy, but also they are vetted from a psychometric standpoint, is it a fair question, is it a confusing question?
The credentials committee is charged with reviewing the applicants and to evaluate our eligibility requirements—to make sure those requirements are relevant. I think the mentorship program will be an example of that. Another example of a change is when it comes to achieving and maintaining a credential is the recognition of volunteer hours. We have lots of CDEs who may volunteer in diabetes camps. They might be able to go with group campers for a week, getting many hours of volunteer education. We’ve changed that and said this is worthwhile and should be recognized for maintaining a credential.
We are also looking at professionals who might not be eligible for the credential. One of the things that makes it difficult to define a CDE is that it is not just nurses, dietitians, or physicians. There are pharmacists and podiatrists, and we are also seeing community healthcare workers.
We are pushing back, [and asking] are our assumptions about who qualifies to be a CDE still relevant to today or on the other hand as we see healthcare changing, adapting, how are we going to adapt to our credential, our requirements?
As health plans move to use community health workers we want to make sure those workers are operating at the highest levels on behalf of the persons with diabetes. We need to make sure that if different groups are going to be looked at for education how do we credential them? We may have to come up with different types of credential underneath the broader banner of CDE, much like a general internist or a cardiologist. I can’t say today what that will look like in the end, but we need to be relevant.
Feedback: Do you think certification of diabetes education should be expanded to include other medical professions? Who do you think should be considered for inclusion? Email your response to email@example.com.
Originally posted by DiabetesCare.net on April 11, 2011.