Focus on the American Association of Diabetes Educators (AADE) and its 27th annual meeting, San Diego, 2000

The aim of the AADE is to advance the role of the diabetes educator. The 27th annual conference was titled, ‘The Diabetes Education Adventure, Focus on Innovation’, with an emphasis on changing education away from content driven to process driven. Instead of ‘I've done my job by telling them’ but to educate in a way that changes behaviour. Education is at the heart of good diabetes self-management. Diabetes educators are health professionals who specialise in promoting independence by teaching self-management skills to those with diabetes to enable better health and lifestyle choices. The aim of this meeting was to help us as diabetes educators explore new opportunities, let go of old ways and open our minds to possibilities. In America and Canada, any health care professional can become a Certified Diabetes Educator [CDE], most are nurses and dietitians. There is a National Certification Board for Diabetes Educators whose mission is to promote excellence in the profession of diabetes education through the development, maintenance and protection of the CDE. To qualify they have to complete a course in diabetes management and gain 1000 hours working in diabetes. Certification is valid for five years.1 Registration can be done by mail or easier via the Internet, a programme is then sent to you for perusal and if you wish to attend any workshops you must register for these, anyone can attend the concurrent sessions. The programme included 30 concurrent sessions, 24 research presentations and 15 workshops. There was a continuous flow of animated, enthusiastic and well-informed speakers to spark your imagination and motivation. Each day there is an AADE newspaper covering yesterday's events, updating on new products and reiterating what is happening each day. Early registration to the conference enables attendance for 22 pre conference education programmes. All these are accredited sessions. In addition to the AADE programme there are Corporate Sponsored Programmes. These are planned for either before or after the main AADE programme, this does mean that some start early in the morning. However they are worth that early alarm call as they were inspiring and informative, concentration is also helped by the constant supply of culinary delights at your table. This meant that you could attend back to back sessions without worrying about meals and drinks. Comprehensive handouts are given out at each session; these include the speaker's slides. More than 200 exhibits were available so plenty of time is needed for the exhibitions. Advances in technology and treatments often reach the USA prior to the UK. This early insight is exciting and arms you with information to impart to team members and patients. National Standards for Diabetes Self-Management Education [DSME]. Diabetes self-management programmes are recognised as the cornerstone of care for all individuals with diabetes who want to achieve satisfactory health – related outcomes. The national standards for DSME were designed to define quality diabetes self-management education that can be implemented in diverse settings to facilitate improved health care outcomes. A working task force has taken two years to critically review current standards and have now published ten; these standards will be reviewed every five years.2 At present in the UK, we do not have national standards. With the introduction of the National Service Framework, it would seem appropriate to achieve this, but as with all standards they have to be R.U.M.B.A. Realistic, Understandable, Measurable, Believable, Achievable. Non-diet approach: Imaginative approaches to education demonstrated how different techniques might help different individuals. “Breaking the cycle of resistance; is it medicine or magic?” provided a refreshing reflection of how to rethink our approach to type 2 diabetes. The presenters described experiences of individuals who may initially lose weight only to gain more weight later on; prescribed diets can be short-term remedies but not long term solutions. “Will power lasts two weeks but is soluble in alcohol, it also evaporates in the presence of hunger, emotion and fatigue.” A non-diet approach was proposed to achieve effective weight loss. The programme promoted support, nurturing, enjoyment, no excessive restraints, the removal of weight and food as a life issue and with the promotion of normal eating and physical exercise. The non-diet approach has had some impressive results. Carbohydrate [CHO] counting: CHO counting is back in a big way in the States particularly for patients on insulin pumps and multiple injection therapy. All patients fill in a diet history form which also asks, “Write down two things that you would like to change about your diabetes or eating habits”. Have CHO lists on view. CHO gram counting is easier than exchange counting. Calculate the number of calories needed per day and convert to CHO total and spread over the day. Teach portion control by getting patients to weigh and measure food in the beginning so they can get a feel for the right quantities to have. Technology: Advances in technology are swift and at the conference, there is plenty of time to view the new devices or see prototype models. In particular at this meeting was the GLUCOWATCH. The Glucowatch not only measures the tissue glucose every 20 minutes but it indicates whether it's going up or down, very useful for hypo-unawareness and prior to driving. The glucowatch is situated on the wrist and each sensor lasts for about 12 hours, readings can be affected if there is increased sweating on the skin. Education on the use of this watch is very important. Continuous Glucose Monitoring System [CGMS]: The CGMS continuously measures glucose in the tissue for three days. There is a stabilisation period of one hour for each usage and regular HBGM is still needed. After three days, the data is then downloaded for interpretation, there is no way that the readings can be seen during the three-day period. Experience so far has shown that many patients are hypoglycaemic for long periods through the night and yet can wake with normal fasting blood glucose levels. Biosensor: This is a multiple test meter. One meter can test for glucose, ketones, cholesterol and HDL cholesterol. Basically it has a different chip for each different test. It is comparable to laboratory testing. Future developments will include chips for HbA1, LDL cholesterol, creatinine and micralbiminuria. Could this be a new way forward to reduce lab testing which so many patients hate?3 Testing for Diabetic Autonomic Neuropathy: On display was a monitor to record heart variability rate, which is an indicator for autonomic neuropathy. The system by ANSCORE from bostonmedical technologies is new in the US. Monitors are being placed in clinic settings. Blood Glucose Monitoring: It is now general practice in the USA for patients to perform one-hour postprandial testing as control improves when these levels are targeted, but there are no studies to prove this yet. If the one hour tests are >6.6 mmol/l in pregnancy, a higher risk of macrosomia has been seen. Hopefully you now have a flavour as to why we felt compelled to write about the AADE. It is beneficial to see the advances in technology first hand as it helps to answer patients questions as to what is on the horizon, but more importantly as diabetes nurse specialists it is the motivation gained to introduce new ideas to help patients with self-management which is now recognised as a real issue in helping to improve the health and quality of life of the person with diabetes.

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