• Fresh Views

    Language Matters Global Summit

    We’re taking a bit of a detour this week in our “Diabetes Technology and Solution-Focused Practice” series to focus on a special event – a Facebook Livestream Language Matters Global Summit. 

    We @AFreshPOVForYou have been supporters of the #LanguageMatters movement in diabetes care and education since early on. You can read previous blog posts here and here.

    Initially, when the Diabetes Australia Language Guidance Paper was published here, we were off and running, trying to incorporate strength-based, person-first language into all that we did. Deb was working at Sutter Health at the time and started a National Diabetes Month/World Diabetes Day campaign to educate healthcare professionals within the system about the rationale behind the movement and the meaning behind the words.

    Soon after the United States guidelines were published jointly by both the Association of Diabetes Care and Education Specialists (ADCES- formerly AADE) and the American Diabetes Association (ADA) the Use of Language in Diabetes Care and Education (Dickinson, JK, 2017) here. We were then even more inspired.

    As we’ve written about before, we were involved in the script development and production of the Telly Award winning video “Changing the Conversation,” with a purpose to raise awareness of the power of language and the impact language can have on a person’s well-being, quality of life and overall sense of self while living with diabetes. We’re so proud that this video has been shown around the world!

    And the use of language is the foundation of this solution-focused blog. We believe and live these principles every day and work to help others embrace the important messages and translate them into their relationships with their clients and co-workers.

    Yesterday, October 19, 2021 Diabetes Australia celebrated 10 years of moving the needle forward in the #LanguageMatters movement by hosting a Facebook Livestream Language Matters Global Summit. We were thrilled that this event included a showing of the Changing the Conversation video and Deb was so humbled to introduce the video once again to new audiences.

    As October turns to November and Diabetes Month activities, please consider sharing the YouTube link to this event and continue to raise awareness about the importance of and need to change the way we talk about diabetes to help stop the stigma, shame and blame often associated with a lack of knowledge combined with media hype around diabetes.

    We can all make a difference when we believe that #LanguageMatters!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    3 Solution-Focused Fresh Starts for Fall

    “Step out of the history that is holding you back. Step into the new story you are willing to create.” —Oprah Winfrey

    Lake Nevin at Bernheim Forest and Arboretum

    Fall has arrived! While some consider Fall an “ending” with the wrap-up of the glorious long days of summer, we here @AFreshPOVforYou think of Fall as a time for new “beginnings”. The air takes on a crispness. The trees magnificently change colors and leaves begin to fall. And it’s the perfect time for a solution-focused fresh start or two (or three)!

    Today we’re sharing 3 solution-focused fresh starts for Fall that you in turn can share with your clients/patients: 

    1. Fit a few more steps into the day. With shorter days and cooler temperatures it can be easy to become more sedentary. We know walking is good for us, and doesn’t require any equipment other than some well-fitting walking shoes. A favorite way to fit in more steps is to intentionally stand up every 30 minutes or so during the day and walk around for 2-3 minutes. That activity has been shown to benefit blood glucose and heart health. We’re also big fans of fitness trackers to keep up with how many steps are accumulated during the day, then try to bump that average up by 500 per day. Once that’s achieved, try adding another 500, and so on, working toward a goal of 10,000 steps each day. Read more about solution-focused practice applied to activity tracker conversations in a previous post here.
    1. Enjoy Fall vegetables (of the non-starchy variety). In fact, try filling half of your plate with these! Flavorful fall bounty includes arugula, carrots, broccoli, Brussels sprouts, cauliflower, kale, radishes, and spinach. These are all very low in carbohydrate (only 5 grams in a 1-cup serving raw or ½ cup cooked), so can help keep post-meal BGs in target and help bring more time in range. Plus, these veggies are packed with fiber to help fill you up. One of our favorites is roasted Brussels sprouts. Roasted radishes and roasted broccoli are pretty fantastic too! While Tami’s not a fan of raw radishes, roasted radishes are a different story. She’s found they become sweet and lose the bitterness when roasted. If you’ve never roasted vegetables, here’s the simple “how to” here. 
    1. Check-in on those New Year’s “solutions” (rather than resolutions) that you set 9 months ago. You can read more about our take on setting New Year’s “solutions” rather than “resolutions” here. This solution-focused approach focuses on things that have gone well in the past, and pinpointing how you can do more of that (rather than trying to change in the new year). Autumn is the perfect time to see what you have accomplished and had success with, and look ahead to what you want to do before the year closes out. 

    Find 3 more solution-focused fresh starts for Fall in our blog here from 2019.

    Stop back by in 2 weeks when we’ll share a few favorite apps that can be used in solution-focused practice. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Noom App

    Noom messaging to support healthy thinking!

    We at A Fresh POV for You hope you enjoyed summer and are now heading into fall with excitement and initiative!  As we continue our series on diabetes technology, today we’re sharing Deb’s experience with the Noom app. Both of us have used many different apps for healthy living, some of which we’ve written about in past blog posts. 

    Deb started using Noom recently because of all of the great things she was reading and hearing about the psychology behind behavior change.  While our goal as diabetes care and education specialists is to incorporate behavioral techniques into practice, including solution-focused practice, it’s often challenging to have enough time to teach the skills needed to embrace the behavior change. That’s where Noom comes in. 

    What’s interesting about Noom is that you answer many survey questions including history, habits and desires, then Noom crafts an ideal plan for weight loss or making healthy choices before you have to decide to commit to the cost. Noom incorporates several behavior techniques including Cognitive Behavioral Therapy. The overarching premise of Noom is to help people set small, achievable goals, so that as those are reached one will stay motivated, thus building  self-efficacy, which helps boost motivation.

    Noom has several statistics they share regarding their success rate. We only have the reports and can’t share personal experience as we are new to this app and technique. Some insurance plans will cover the Noom program and Noom will facilitate the process.

    What’s different about the Noom app is the psychology lessons each day – you choose how many minutes you want to engage, Deb’s been doing 10 minutes a day. The app encourages taking notes, writing down calls to action, setting goals and documenting them. Overall the theme of Noom is “I believe I can change my behavior”.  And it’s encouraged that the user reminds himself as time goes on.

    Noom also creates a social connection. There are Noom community groups as well as a Noom coach if one chooses to engage. The language used in the app is very encouraging, person first, and a questioning approach is used.

    So what does this have to do with a solution-focused approach? The psychology behind Noom assumes that the user has the power they need, but they need support and coaching to help develop positive thinking. That is a key component of a solution-focused approach – to start with the strengths of the individual and then build upon them. And as stated, they use a questioning approach, encouraging the individual to think about what might work for them as opposed to setting a strict plan.

    If you’ve been reading our blog you know we’ve written about the WW app (the old Weight Watchers) and some of the positive messaging we’ve seen from that app. We would say that Noom goes one step farther in teaching the mini-lessons focused on psychology.

    As with any healthy living app, the best app is often the one that resonates with you or your clients. If your clients are looking for something new, this might be an option, depending on costs.

     Please note that this blog is our personal experience and we receive no financial incentives from Noom.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Celebrating Labor Day Weekend!

    One of a few remaining Sunflowers in a field at the end of summer in Santa, Fe, New Mexico

    With the start of September and Fall on the horizon we @AFreshPOVforYou took a much needed break to celebrate this long weekend. Deb finally got to see her daughter walk across the stage during a very delayed 2020 college graduation ceremony. And Tami enjoyed a low-key “staycation” with her hubby…dinner outing with friends, family picnic, hanging out on the back porch in the cooler temps, appreciating the last of the sunflowers in her garden, binging Netflix, and bringing out the fall decor!

    Sunflowers in Tami’s backyard

    So we invite you to enjoy reading a past blog post from 2019 A Fresh Start in the Fall where we share 3 solution-focused fresh starts for Fall. In upcoming posts we’ll share some of our current approaches and what we’re doing to gain a fresh start. Deb recently started using the Noom app and she’ll be sharing her views on their strategies to make technology support healthy choices. Tami is renewing her focus on mindfulness, being present in the moment and practicing gratitude. 

    We hope you too took some time this long weekend with friends, family, nature or whatever makes you smile and rejuvenates you!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Telehealth: A solution-focused practice

    Lorena Drago, MS, RDN, CDN, CDCES

    As telehealth continues to be a key aspect of healthcare, we reached out to our friend and fellow diabetes care and education specialist Lorena Drago MS, RDN, CDN, CDCES, owner of Hispanic Foodways LLC, to share her experience and solution-focused approach to engaging in successful telehealth visits.

    Here is what Lorena shared with us….

    Many health professionals have now adopted telehealth visits as part of diabetes care and education. I must admit that it has been a bumpy ride for health care providers and patients. Many of us have experienced technical issues. We are familiar with the “Can you hear me now?” plight as we connect to audio or have fallen victim to nostril intimacy when the patient moves the camera too close to the face. Let’s not mention those patients who believe pants are optional.

    Overall, there are many advantages to telehealth, such as convenience, saving time, and saving money on travel. Despite working out some kinks, there are still some challenges, such as lack of internet, poor connectivity, and low digital health literacy.

    After a year and a half of telehealth visits, I would like to share my solution-focused practice approach to optimizing virtual visits.

    BEFORE THE VISIT: PREPARATION IS KEY

    FOR THE PATIENT

    Create a checklist and review with patient prior to the appointment.

    • Does the patient have access to a computer, laptop, tablet, or phone?
    • Does the patient have internet access? 
    • Have they downloaded the application they will use for the telehealth appointment? Do they need help? Do they know how to use it?
    • Do they have a quiet designated space for the telehealth appointment?
    • Has the patient completed labs, if required?
    • Does the patient have his/her anthropometric measurements?
    • Does the patient have his/her blood glucose results available?
      • Is the patient able to upload his/her results into the hospital/clinic portal?
      • Is the patient’s meter, CGM, smart insulin pens, and pump connected to a platform where the health care team can access the information?
    • Have they completed the required patient forms prior to the appointment? 
    • Do they have insurance information?
    • If it is a nutrition appointment, do they have foods and labels they would like to discuss?

    A patient navigator or administrative staff can compile this information and help prepare the patient for the visit. For patients who experience some of the aforementioned challenges, a telephone visit may be preferable.

    FOR THE DIABETES CARE AND EDUCATION SPECIALIST

    Prepare the agenda for the visit.

    What does the patient want to know? I ask the patient:

    • What are 1-2 questions you would like answered before the end of this appointment?
    • What would you like to learn today?
    • What is going well with your diabetes management?

    Build on what the patient already knows.

    If you can share the screen, show the patient a list of foods. Ask, “which of these foods raise your blood glucose the most? If you are not sure, just tell me you are not sure.” After the individual selects the foods, I know what the knowledge gaps are, and I shift the education to bridging the gaps in knowledge.  For example, I provide a handout with pictures of whole wheat bread, skim milk, whole milk, fish, carrots, nuts. If the patient says that whole milk raises blood sugar and skim milk does not, then I focus on discussing the difference between carbohydrates and fat.

    Focus on the wins.

    When you discuss glucose management, it is common to focus on out-of-range results. After all, it is paramount to identify and manage hypoglycemic events. However, there is an inherent fear that the healthcare provider will admonish the patient for poor results. To avoid this, I ask:

    What do you think happened?

    This question invites exploration and reflection. Allow the patient to pause and reflect. Usually, patients will say, “I forgot to eat, or I did not eat enough carbohydrates.” Ask,

    What have you done in the past that has worked for you to remind you to do something?

    This question will allow the patient to recall past effective strategies and positive outcomes.  If the patient doesn’t come up with any answers, then offer suggestions that have worked for other patients.

    Make sure to use teach-back. Ask: 

    Can you tell me or show me in your own words.  Can you summarize the key points of today’s visit?

    Goal setting

    Establishing goals is often tricky for some patients. I usually create a list of goals and ask the patient to select an easy win. This way, it is easy to achieve, and the patient will be more likely to move forward. For those patients who are goal driven, formulate more complex goals and adapt to the patient.

    AFTER THE VISIT: DATA REVIEW IS REIMBURSABLE

    CPT Code & Service Provided

    • 95249: Patient equipment, CGM placement, hook-up, calibration, training, sensor removal, and printout recording.
    • Service performed by: MD, NP, PA, RN, PharmD, RDN, CDCES
    • Reimbursement: Medicare: ~$55, Commercial ~$127

    95251: CGM data interpretation

    • Service performed by: MD, NP, PA
    • Reimbursement: Medicare ~$40, Commercial: ~$100

    99457, 99091: Remote patient monitoring; collection and interpretation of physiologic data

    • Service performed by: MD or other qualified health professional
    • Reimbursement: Medicare: ~$50-$60

    Lorena created the Diabetes Teaching Tools for your Virtual Practice to help diabetes educators:

    • Reduce consultation time
    • In less than 3 minutes, identify what the client doesn’t know so you can focus on what the client needs to know.
    • Engage the client in the learning process using “real-life examples.”

    The diabetes teaching tool kit includes:

    • 13 topics presented in a simplified-visually rich style
    • 8 interactive activities with real-life examples to help patients use newly acquired information
    • Tried and true carbohydrate knowledge assessment tool so you know what your patients know and don’t know about foods with carbohydrate
    • Download and share with your patients: https://rd2rd.com/downloads/diabetes-teaching-tools-for-your-virtual-practice/ 

    We thank Lorena for the multitude of solution-focused practice pearls she shared with us and our readers in this week’s blog!

    Stop back by in 2 weeks to see what we write about as we continue to share about a variety of other technologies that impact and influence diabetes care and education!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Adopt a Fresh Point of View: A Solution-Focused Approach to the ADCES7

    We hope you’re finding a little fun and relaxation this summer, and that you’re enjoying a few inspiring and fresh views along the way!  If you’ve been following us, you know that we often share a fresh view that has inspired us, in coordination with our fresh point of view of the week…all as we guide healthcare professionals in a solution-focused approach to practice, so clients can embrace possibilities, opportunities, and a fresh vision for the future.

    Last time we shared some #ADCES21 sessions we are interested in attending and this week we’d like to share a little more about our A Fresh POV for You session!

    Wondering what is a solution-focused approach to practice? 

    As a quick summary of how a solution-focused approach compares to a “traditional” counseling approach, we’re sharing with you a snapshot from our upcoming presentation Saturday August 14, 3:15-3:45 Central at the virtual Association of Diabetes Care and Education Specialists Annual Conference. The presentation is titled “Adopt a Fresh Point of View: A Solution-Focused Approach to the ADCES7”. (The ADCES7 refers to the 7 identified self-care behaviors related to managing diabetes.) 

    We invite you to join us at our presentation where we’ll:

    • Describe elements of a solution-focused approach to client interactions.
    • Share how to apply a solution-focused approach when using the ADCES7 self-care behaviors in practice. AND 
    • How to guide clients in identifying “exceptions” to strengthen resilience and confidence to manage diabetes

    We’ll be there live chatting with you throughout to get all of your questions answered! Please reach out to us on social media during the conference!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Association of Diabetes Care and Education Specialists 2021 Virtual Annual Meeting Preview

    We hope your summer has been going well! We’ve been busy with work and spending time with family.  Here @AFreshPOVforYo we are getting excited for the upcoming ADCES21 Virtual conference. For those of you that are attending, we have highlighted 13 presentations that are interesting to us and align with our thinking around behavior change, person-centered care, use of language, and of course use of technology.  While there are many, many more sessions we plan to join, we are showcasing just a few!

    We hope you’ll attend our session on Saturday 8/14/21 at 3:15 pm CT, S30 – Adopt A Fresh Point of View: A Solution-Focused Approach to the ADCES7 Self-Care Behaviors™.  We presented two years ago at #AADE19 and shared an overview of what a solution-focused approach is all about. This year we’ll go a little farther and address the ADCES7 self-care behaviors. We’ll be sharing more info about our program in two weeks, so stay tuned for that!

    While we wish we were connecting with our colleagues in person this August, we appreciate the great program put together virtually. We’re crossing our fingers that we’ll be grabbing a coffee or a glass of wine at ADCES22 in Baltimore next year!

    Enjoy the meeting if you’re attending! We’ll share some of our thoughts about the meeting in a future post. We’ll also be Tweeting during the conference to share some pertinent information!

    T02 – Help People With Diabetes Shift Their Mindset and Change Their Approach to Self-Care Behaviors

    Mark Heyman, PhD, CDCES

    Thursday 8/12/21 10:35-11:05 am 

    In this session, presenters will show a framework for how diabetes care and education specialists can empower people with diabetes to take a new relationship approach to change their entire emotional experience with diabetes to improve self-care behaviors.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Describe a framework for empowering people with diabetes to change their emotional experience with diabetes
    • Describe how different types of relationships with diabetes impacts psychosocial and emotional functioning
    • Utilize practical tools to help people change their relationship with diabetes

    T10 – Achieve Better Outcomes by Using Individually Customized Messages

    Marlisa Brown, MS, RDN, CDCES, CDN

    Thursday, August 12, 2021

     12:45 PM – 1:15 PM

    This session will discuss how to achieve better results by combining smart goals, virtual programs, motivational interviewing, coaching, stages of change and behavioral strategies with customized messages designed individually to improve outcomes.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Combine behavior change techniques with customized messaging designed to improve individual outcomes
    • Embrace fears and help an individual to overcome barriers
    • Identify a starting point and build an action plan

    T17 – Collaborative Psychosocial Care for Youth With Diabetes

    Korey Hood, PhD

     Thursday, August 12, 2021

    1:20 PM – 1:50 PM

    Psychosocial care for youth with diabetes presents challenges for the care team. This presentation will cover engagement and treatment strategies that optimize diabetes care in youth and collaborative care provided by diabetes care and education specialists and mental health professionals.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Identify psychosocial care opportunities in youth with diabetes
    • Select validated surveys and screening formats for identifying psychosocial issues in youth with diabetes
    • Adopt concrete strategies to help youth with diabetes

    T18 – Language in Diabetes Care From a Personal and Professional Perspective

    Lauren Plunkett, RDN, LD, CDCES

     Thursday, August 12, 2021

    1:20 PM – 1:50 PM

     Living with a disease that focuses on numerical values and patterns can be physically and mentally exhausting. Presenters will examine statements that trigger sensitive emotions and how to replace them with optimistic, inspirational coaching.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Collaborate with individuals to understand how they approach management of their diabetes
    • Articulate optimistic coaching methods to encourage individuals to live in partnership with diabetes
    • Reframe the standard clinical approach to a perspective that focuses on the individual experience

    T27 – Diabetes Stigma: Causes and Consequences for the Concerned Clinician

    Lauren B. Beach, JD, PhD

     Thursday, August 12, 2021

    3:25 PM – 3:55 PM

     In this session, participants will learn how diabetes stigma at individual, interpersonal and structural levels intersect and can compound other forms of social marginalization, contributing to health disparities and poorer outcomes.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Define diabetes stigma and name at least four dimensions of stigma
    • Name pathways by which diabetes stigma is associated with medication taking among people with diabetes
    • Promote diabetes pride in your practice and across the interdisciplinary diabetes care team

    F04 – Too Good? The Potential Dangers of Perfectionism in Diabetes

    Kersti Spjut, PhD

    Alexis Skelley, LISW-CP, LCSW, CDCES

     Friday August 13, 2021

    10:05 AM – 10:35 AM

     This session will provide ways to recognize signs of unhealthy perfectionism in diabetes management, its medical and emotional risks, and tangible steps for helping individuals become more flexible, mindful and compassionate approach.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Explain how perfectionism exhibits in diabetes management
    • List possible consequences of perfectionism in people with diabetes
    • Utilize strategies for preventing perfectionism pitfalls among people with diabetes

    F17 – Practical Approaches for Addressing Behavioral Health Needs

    Nicole Bereolos, PhD, MPH, MSCP, CDCES, FADCES

    Friday, August 13, 2021

    12:40 PM – 1:10 PM

    Performing an assessment of behavioral health needs in individuals with diabetes can be limited by lack of training, resources and time. This session will provide practical tools, resources and real-world examples to augment learning in this area for diabetes care and education specialists.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Identify the importance of addressing the behavioral health needs of PWD
    • Demonstrate real-world applications of addressing behavioral health needs
    • Utilize tools and resources appropriately to help address behavioral health needs in practice

     

    D07 – Diabetes Care and Education Specialists and Behavioral Coaching For Mental Health: Creating Successful Partnerships

    Korey Hood, PhD,

    Brooke Benton, CDCES, MS, RD, LDN

    Sunday, August 15, 2021

     10:05 AM – 10:35 AM

    Mental health issues can prove challenging to address for diabetes care and education specialists. This session will discuss how a behavioral coach can work alongside them to screen for mental health issues, recognize when individuals are struggling and connect them to available support resources.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Highlight models that promote partnership between the diabetes care and education specialist and the mental health specialist
    • Discuss the relationship between diabetes and mental health
    • Incorporate screening tools and identify referring sources to collaborate with for providing mental health care

    D19 – Diabetes Distress: An Overview of Prevalence, Assessment and Treatment

    Lawrence Fisher, PhD, ABPP

    Sunday, August 15, 2021

     11:15 AM – 11:45 AM

    This presentation will review the definition, clinical presentation, prevalence, assessment and treatment of diabetes distress due to its high prevalence and consistent links with self-management, making it an important target of clinical care.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Perform a clinical assessment for diabetes distress
    • Utilize recommended tools for clinical assessment of diabetes distress
    • Discuss the treatment of diabetes distress

     D25 – Optimize Support During Crises With Supplemental Peer Support

    Anna Norton, MS

    Sunday, August 15, 2021

     11:50 AM – 12:20 PM

    During the COVID-19 pandemic, peer support communities can serve as a supplemental resource for people with diabetes to maintain their mental health well-being. This session will provide strategies for diabetes care and education specialists to connect people with diabetes to these communities.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Recognize the need for psychosocial support for people with diabetes during a crisis
    • Provide suggestions and strategies for connecting people in their practice to peer support communities
    • Identify reputable resources for diabetes management outside of the healthcare environment

    Here are a few technology sessions you may be interested in as well.  

    T24 – Facebook Collaborative To Improve Diabetes Management

    Lorena Drago, MS, RDN, CDN, CDCES

    Miguel Johns, BS

    Thursday, August 12, 2021

     2:50 PM – 3:20 PM

    Sharing diabetes challenges and engaging with peers through Facebook groups helps people with diabetes make connections and learn/reinforce actionable self-care behaviors. This session will discuss how to use social media to teach, reinforce and support people with diabetes.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Discuss how sharing diabetes challenges fosters connections and improves self-care habits
    • Increase diabetes education support outside of the provider’s office using social media marketing strategies
    • Create engaging social media content to obtain measurable results

    ET07 – Powered by Dexcom: Continuous Glucose Monitoring Empowers Self-Management and Expands the Horizons for Connected Care

    Moderator: Deborah Greenwood, PhD, RN, BC-ADM, CDCES, FADCES
    Clinical Education, Dexcom

    Panelists:
    Malinda Peeples, RN, MS, CDCES, WellDoc

    Denise MacKenzie, RPh, PharmD, CDCES, OnDuo

    Aimée José, RN, CDCES, Steady Health

    LaurieAnn Scher, MS, RD, CDCES, Fitscript

    Lindsay Vettleson, RDN, CDCES, ACE-CPT, ACE-CHC, One Drop

    Friday, August 13, 2021

     10:45 AM – 11:30 AM
    Join the discussion with DCES digital health experts that are leading the development and implementation of digital platforms to support people with type 2 diabetes to engage in personalized, data-driven, self-management and support coaches and HCPs to inform therapeutic decisions.

    S04 – Technology Interventions in High-Risk Populations: The Identify, Configure, and Collaborate (ICC) Framework in Action!

    Donna M. Rice, MBA, BSN, RN, CDCES, FADCES

    Deborah A. Greenwood, PhD, RN, BC-ADM, CDCES, FADCES

    Saturday, August 14, 2021

     10:05 AM – 10:35 AM

     This presentation will describe the ADCES technology framework Identify, Configure and Collaborate (ICC) using a program that delivers care with technology-enabled devices in high-risk communities.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Describe the Identify, Configure, and Collaborate (ICC) framework and its application to high risk populations
    • Discuss the role of the diabetes care and education specialist in evaluating technology interventions within their practice
    • Discuss a technology assessment tool that can be utilized to assess specific technology needs

    We’ll see you in two weeks with a more detailed description of our Saturday educational session!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Summer 2021 Fresh Views

    Wedding shower floral arrangement and cranberry mimosa from Deb’s niece’s COVID delayed bridal shower

    Happy Summer from us here @A Fresh POV for you! We are taking a little break to refresh and recharge. As we continue towards our Mission to guide healthcare professionals in a solution-focused approach so clients can embrace possibilities, opportunities, and a fresh vision for the future, you will not want to miss our next post on interesting educational sessions we’re excited about during the upcoming Association of Diabetes Care and Education Specialist ASCES21 Annual conference August 12-15, 2021! 

    In the meantime, we thought you might want to revisit this blog we posted on healthy eating following the  Mediterranean style eating plan or this post on Keeping Friends Close!

    If you’ve followed our blog, you know that we enjoy sharing a fresh inspiring view with each post. Here are a few fresh views that we have enjoyed this summer!

    Deb’s family and friends relaxing at Lake Champlain, Cholchester, Vermont
    The beautiful Popponesset Beach, Mashpee, Cape Cod, MA

    We hope you are enjoying your summer and have the opportunity to “Imprint” some Fresh Views of your own! See you back on July 28!

    Tami & Deb

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Online Peer Support Community Intervention to Address Health Disparities

      “I realized that my sugar was like a rollercoaster. It would go up and down very clearly. So I started to go for walks. Not light walks, but fast-paced ones.” ~Study participant

    Since the COVID-19 pandemic began the disparities in diabetes technology use in underserved populations has risen to the forefront. During the recent American Diabetes Association (ADA) Scientific Sessions data were shared about a novel use of an online peer support community combined with continuous glucose monitoring (CGM) use to educate, engage and empower people with type 2 diabetes. Since Deb was a co-investigator on this study, we reached out to Dr. Michelle Litchman, PI, Assistant Professor, University of Utah, College of Nursing to discuss the study findings and impact.

    The ADA abstract: 151-O Using a CGM plus Online Peer Support Community Intervention to Address Health Disparities

    Dr. Litchman, what makes this study unique and important?

    This study was developed based on two separate PCORI-funded projects that incorporated community-based participatory research principles and community advisory boards (CAB). The first CAB partnered with individuals within the Hispanic community to better understand diabetes technology needs and desires. The second CAB included diabetes online community partners to best understand how online peer support could reinforce diabetes technology use and healthy behaviors.

    What were the components of the study?

    We developed an intervention that combined continuous glucose monitoring (CGM) plus an online peer support community (OPSC). To support the needs of Hispanic and Spanish-speaking adults with type 2 diabetes not using insulin, the CGM+OPSC intervention was optimized to be culturally and linguistically appropriate. Participants wore CGM to visualize their daily glucose patterns and engaged in weekly personal experiments. Personal experiments included health behavior challenges related to general diabetes topics (being active, healthy eating, etc.) and were posted to the OPSC weekly. The OPSC were managed by trained Spanish/English bilingual peer facilitators who also lived with diabetes and used CGM. This mixed method study assessed how participants used the intervention.

    Participants completed a 1-week blinded baseline CGM recording (N=31) then engaged in the CGM+OPSC intervention for 12 weeks. Of those that continued into unblinded phase (n=22) study engagement was excellent (N=21).

    What were some of the key outcomes of the study?

    We analyzed exit interviews and identified 3 themes: (1) CGM “personal experiments” helped participants gain knowledge about how diet, exercise, medications, stress, and sleep impacted glucose levels; (2) the OPSC reinforced healthy behaviors through personal experiments, collective learning and social support; and (3) CGM engagement increased OPSC participation and participation in the OPSC resulted in greater CGM utilization, suggesting a positive feedback loop.

    We also found that self-efficacy levels significantly improved when comparing pre to post intervention.

    Tell us about the figure you presented.

    The figure above describes a positive feedback loop in which CGM could help see how glucose levels changed when they engaged in health behaviors, and the OPSC provided structure (personal experiments) and emotional and informational support to reinforce healthy behaviors. The promise of diabetes technology can only be seen with continued use. This study showed that an OPSC is one way to enhance CGM use. It is possible that OPSC could support other diabetes technologies and in other populations or languages.  

    Tell us more about the peer facilitators.

    We hired and trained five Hispanic Spanish/English bilingual individuals who were living with diabetes and using CGM. Having a group of peers that the participants could relate to was critical to the study’s success. The peer facilitators could provide tips and tricks from their own lived experience while also providing encouragement to those who might be struggling. All peer facilitators were supported by the research team and a bilingual certified diabetes care and education specialist. After the study completed, the peer facilitators helped develop training videos to support future research.

    What is the key message you would like readers to take away today?

    Hispanic, Spanish-speaking adults with type 2 diabetes have a great desire to use diabetes technology. However, diabetes technology must be optimized for language, cultural and social support needs. The CGM+OPSC intervention provided participants with the tools necessary to learn, problem-solve, and make healthy behavior changes and is a promising intervention to address health disparities.

    Is there anything else you would like us to know?

    This study would not have been possible without important community partners. We thank the CABs from both PCORI studies who helped guide us to developing this novel intervention.

    Of note, this abstract was awarded “Best Abstract” in the Glucose Monitoring and Sensing presentation group! We congratulate and thank Dr. Litchman for sharing the ADA presentation with us and look forward to future publications.

    Stop back by in 2 weeks to see what we write about as we continue to share about a variety of other technologies that impact and influence diabetes care and education!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients.

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Blood Glucose Monitoring Discussions

    A field of flowers representing multiple fingersticks associated with monitoring via a meter

    As we continue our series on Diabetes Technology and Solution-Focused Practice, this week we’re focused on conversations around interpreting blood glucose data obtained via monitoring with a blood glucose meter. (You can find a post a few weeks back on continuous glucose monitor (CGM) data discussions here.) While more and more people are using CGM to stay in touch with their glucose levels, monitoring via a blood glucose meter and fingerstick or alternate site blood sample, continues to be an important diabetes technology for many individuals. 

    Focus first on blood glucose in target, rather than the outliers

    How was that accomplished? When evaluating blood glucose logs and patterns, a typical first response may be to focus on the glucose values out of range and try to identify what went wrong at those times. However, what if the first focus was on blood glucose in the target range, and what was going on to accomplish that?

     If we only focus on times that are not working well, we miss identifying successes.

    There are at least 42 identified factors that can impact blood glucose (while in reality there are likely even more if you include mental health and other daily issues). 

    Monitoring is helpful, for instance, to learn how a meal affects blood glucose. By “checking in pairs” pre and 1 ½-2 hours post meal when blood glucose is generally peaking, it’s easy to see and learn the impact of the type of food and portions eaten.There’s so much to learn!

    Glucose numbers provide information

    From our years in practice we’ve learned that people who live with diabetes have different perceptions around monitoring. For some, it can become an obsession – they need to know where their blood glucose is all the time. It can certainly be a mental burden. And others may not want to focus on their blood glucose. Knowing their number may create negative feelings, fear of judgement and guilt. So, they choose to not check their blood glucose to provide a sense of safety and self-preservation.

    We know that glucose numbers are simply that……they are numbers, and numbers provide information.  The goal of monitoring is to generate data to help people make choices and changes. Numbers are not good or bad and are certainly not a test score. You may have recently seen this image below on Twitter and/or the discussion around it. This is NOT a solution-focused approach! 

    Photo credit: Renza Scibllia’s Twitter account

    When working with clients instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to apply a solution-focused twist to the conversation:

    Try this: You’ve been working hard to fit in physical activity (…or fill in the blank). In looking at your blood glucose checks, what small steps can you take in the direction toward the goal of seeing more values in target?

    Try this: You mentioned you’ve had a lot going on and a really stressful few weeks. Yet you were still able to check your blood glucose twice this past week. How did you manage to accomplish that?

    Try this: I see that your A1C is in your target range. How did you manage to do that? (Instead of your A1C is outstanding, A+ as in the above image!)

    We challenge you each week to try incorporating some flips or twists into your conversations and let us know what impact they have. Stop back by in 2 weeks to see what we write about next in this series of technologies that impact and influence diabetes care and education. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

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