Diabetes Education Is As Effective As Medicine, But Few People Get It

A proven training model helps diabetics control their disease, but only fraction of people have access to it. On Wednesday, pharmacist Jasmine Gonzalvo urged state lawmakers to make it easier for patients to access the training model, Diabetes Self Management Education or DSME.

A clinical pharmacy specialist at Eskenazi Hospital and associate professor of pharmacy at Purdue University, Gonzalvo said the training is the national standard for managing glucose levels. There are many programs in Indiana that teach this model, yet fewer than 4 percent of people diagnosed with diabetes in 2016 received the training. This number Gonzalvo said, “is devastatingly low.”

She spoke about this Wednesday at the Indiana legislature’s interim public health study committee which was considering ways to tackle the disease. Diabetes rates on the rise in Indiana, where over 11 percent of residents have the disease, according to recent state surveys.

A new diabetes diagnosis can be overwhelming, Gonzalvo says. “Somebody newly diagnosed with diabetes is expected to learn 150 new tasks,” she said in her testimony. “I don’t know about you but I can’t learn 150 new things in one appointment.”

Diabetes education teaches skills like healthy eating and exercise and monitoring medications. Gonzalvo says just 10 hours of education can help patients reduce long term risks of the disease.

“The more education you get, the better your glucose is going to get,” she said. With enough education Gonzalvo added, “DSME can be as effective as oral medication.”

Physicians will refer patients diagnosed with Type 2 diabetes to DSME programs, and Medicaid and Medicare will cover several hours of the training. But when faced with a co-pay many patients drop out, Gonzalvo said. She believes this is a major barrier that shouldn’t exist. She also asked the committee to consider increasing the number of education hours reimbursable by Medicaid from four to ten. Currently, Medicare covers ten hours for diabetes education.

Gonzalvo says without access to education patients in Indiana, are not complying with recommended treatment regimes and risk their disease worsening.

“Many patients stop taking medication after six to twelve months,” she said. Even fewer take it after two years. She cited research that shows 60 percent of people with Type 2 diabetes covered by commercial insurance, “are not achieving healthy glucose levels” and close to 70 percent of Medicaid patients.

Gonzalvo knows firsthand how important education is when it comes managing and preventing diabetes. She had gestational diabetes while pregnant with her first child, but says doctors would have missed it “...had it not been for my own knowledge of diabetes.”

“This story was produced by Side Effects Public Media, a news collaborative covering public health.