Regional and rural areas have a higher risk of diabetes-related complications, as healthcare and health advice are more difficult to access.
Diabetes educators aim to provide personalised and individualised advice to those experiencing diabetes and are key health professionals in a diabetes team.
Diabetes educators are increasingly working directly with pharmacy teams to support people with diabetes in managing their medication and overall diabetes care.
Diabetes refers to a set of conditions that differ, although grouped together. The three most common forms of diabetes are:
- Type one diabetes.
- Type two diabetes.
- Gestational diabetes.1
Type one diabetes is an autoimmune disease where the immune system attacks the insulin-producing cells in the pancreas.
Type two diabetes is a metabolic disease strongly associated with genetics, where the body becomes resistant to the effects of insulin and, over time, loses the capacity to produce insulin in the pancreas.2
While type two is linked to modifiable lifestyle factors such as lack of physical activity and obesity; type one diabetes is not.3
Due to the unique nature of the different types of diabetes, providing personalised and individualised care enables each person to manage their diabetes effectively and be directed to the right health professionals for any concerns that may arise.
The National Diabetes Strategy 2021-2030 identifies strengthening diabetes prevention and care as a health priority. The strategy also recognised the importance of a multidisciplinary team of healthcare professionals.4
As understanding about diabetes has heightened, it is increasingly recognised that people experiencing diabetes require a team of health professionals to collaborate to ensure standards of care are being met.
Diabetes educators are key to this as experts in diabetes management; they can ensure that those with diabetes can ask any questions they may have and refer them to the correct health professional.
Overview of diabetes in rural and regional Australia
The Australian Institute of Health and Welfare (AIHW) released its findings on diabetes in Australia in July 2022.
The AIHW records, ‘in 2020, the age-standardised prevalence rate of diabetes according to linked NDSS and APEG data was highest in remote and very remote areas where people were 1.3 times more likely to be living with diabetes than those in major cities.‘5
Assistant Minster for Mental Health and Suicide Prevention and Assistant Minister for Rural and Regional Health Emma McBride said in a statement referring to the AIHW report:
“In Australia, the further you live outside a big city, the harder it is for you to access healthcare.”
Noting the cost of medicines and medication avoidance is an issue that causes overall worst health outcomes. Assistant Minister McBride said: “In many cases, this leads to worse health outcomes, especially for people living with chronic conditions like diabetes, who are facing longer waiting times and higher out-of-pocket costs.
“As a pharmacist, I know that if people skip or delay care, their condition will only get worse – this is bad for their health, it’s bad for our healthcare system, and it’s bad for the economy.”6
What is a diabetes educator?
Diabetes educators are diabetes experts and have completed additional education in learning how people with diabetes can self-manage their diabetes to prevent complications.
Diabetes educators can provide in-depth knowledge and help people with diabetes recognise when they need to see other healthcare professionals.
Diabetes educators from diverse healthcare fields complete rigorous training and continued professional development. To become a credentialled diabetes educator, practice in a related healthcare field is required.7 These fields include:
- Registered Nurse (RN or Division One).
- Registered Midwife.
- Accredited Practising Dietitian.
- Registered Medical Practitioner.
- Registered Pharmacist.
- Registered Podiatrist.
- Accredited Exercise Physiologist.
- Registered Physiotherapist.
A more accessible healthcare sector
Polly Antees, Accredited Practising Dietitian and Credentialled Diabetes Educator is part of the Western Queensland Travelling CDE program through Diabetes Australia.
Ms Antees also runs a private diabetes practice in regional NSW. She recalls studying to become a CDE while managing family life and her dietician practice.
“I am married and had a six-year-old and a three-year-old while I was studying for it. I used to put the kids to bed at 8pm and study from 9pm until midnight during the week. I’d go into my practice on the weekend to finish any assignment work, so I didn’t get distracted. My son said to me when he was three, ‘I don’t need a birthday this year because you have to study.’ I made time to make him a special cake,” Ms Antees said.
Ms Antees says her many years working with people living with diabetes made her want to learn more. Further, the area she worked in did not have a diabetes educator service, prompting her to become credentialed.
“I’d been working as a dietitian with people living with diabetes for about 20 years. There was no diabetes educator service where I was living, so people were being referred to me to help them manage their diabetes. I decided to get the CDE qualification to help my clients,” she said.
The Western Queensland Travelling CDE program is funded by the Western Queensland Primary Health Network and CheckUP. The program allows diabetes educators to travel across Western Queensland to help health professionals and their clients access vital diabetes treatment and care.8 The travelling CDE program regularly visits regional Queensland areas, including Roma, Charleville, Mount Isa, Cloncurry, St George and Cunnamulla. This service is essential in Western Queensland, where people have the lowest life expectancy and are 1.9 times more likely to die from diabetes than the rest of Queensland.9
Diabetes educator’s role
Diabetes educators are trained to provide education on a wide range of diabetes-related management. Ms Antees said: “We help clients in any area they need to manage their diabetes.”
“We can help with the National Diabetes Services Scheme (NDSS) registration to make sure people with diabetes get subsidised access to what they need, such as blood testing strips and needles.”
Here’s a list of some of the ways we can help:
- Education on insulin delivery and correct needle size.
- In-depth discussion of how diabetes medications work.
- Side-effects.
- Continuous Glucose Monitoring and Flash Glucose Monitoring trials and education to get the best results from the technology.
- Registration with NDSS.
- How to order through the NDSS Access Point Pharmacies.
- Call pharmacists on behalf of clients in case clients don’t feel confident about asking questions.
- Assist the pharmacy with ordering NDSS products or alternatives if stocks are low. E.g. pen needles.
- Help organise medication packing, such as Webster, Blister or Roll packs, to help clients keep track of when to take their medication.
Diabetes educators and pharmacy
Ms Antees says CDEs can help ensure medication and devices are being taken correctly and deliver in-home assessments.
“CDEs can help ensure clients are taking the right medication, they’ve got the right devices such as blood glucose meters, and that they’re using testing strips correctly. We can supply GP feedback in case the client needs medication review,” she said.
“We can also promote home medication assessment reviews to be carried out by credentialled pharmacists. The NDSS portal is a godsend, which has streamlined registration and all of the paperwork, including, for example, the medication change form. People can walk out from the first visit with someone like me with their NDSS number and registration completed.”
Personalised care
Providing accessible services like the Western Queensland Travelling CDE program means fewer people are not being left behind and receiving high-quality care. Everyone has different needs and reactions, so personalised care must be available across regional and rural areas.
Ms Antees said: “Everybody is different, and we all have different needs. Bodies react differently to diabetes and medications. People can have different effects and side effects from medications.
“People are also at different points in their diabetes journey, needing different treatment.
“Some people’s lifestyle doesn’t suit medication twice a day, for example. Everyone needs personalised care in managing their diabetes.
“We don’t all like Brussels sprouts. There is no one size fits all with diabetes,” she said.
References:
- Australian Institute of Health and Welfare. Diabetes. 2020. gov.au/reports/diabetes/diabetes/contents/what-is-diabetes [accessed: 26.9.2022]
- Diabetes Australia. Type 1 diabetes. 2022. com.au/about-diabetes/type-1-diabetes/ [assessed: 26.9.2022].
- Diabetes Australia. Type 2 diabetes. 2022. com.au/about-diabetes/type-2-diabetes/ [assessed: 26.9.2022].
- Australian Government. ‘Australian National Diabetes Strategy 2021-2030’. 2021. <gov.au/sites/default/files/documents/2021/11/australian-national-diabetes-strategy-2021-2030_0.pdf> [accessed: 30.9.2022].
- Australian Institute of Health and Welfare.’ Diabetes: Australia facts. 2022. <gov.au/reports/diabetes/diabetes/contents/how-common-is-diabetes/all-diabetes> [accessed: 30.9.2022].
- Emma McBride MP. ‘Impact of diabetes on rural and regional Australia’. 2022. <gov.au/ministers/the-hon-emma-mcbride-mp/media/impact-of-diabetes-on-rural-and-regional-australia#:~:text=According%20to%20the%20AIHW%20report,to%20those%20in%20major%20cities> [accessed: 30.9.2022].
- Australian Diabetes Educators Association. ‘credentialling’. <com.au/credentialling/> [accessed: 21.9.2022].
- Diabetes Queensland. ‘Western Qld opens its doors to diabetes professionals’. 2021. <org.au/news/western-qld-opens-its-doors-to-diabetes-professionals/> [accessed: 11.10.2022].
- Western Queensland Primary Health Network. ‘Western Queensland Diabetes Service Framework’. June 2019. <com.au/uploads/documents/WQPHN_WQ_Diabetes_Service_Framework_A4%20June19%20WEB.pdf> [accessed: 11.10.2022].
This feature was originally published in the October issue of Retail Pharmacy Assistants magazine.
