IDC creates curriculum that works

Results-oriented program focuses on adult models

Results-oriented education for adult diabetics is the watchword of the International Diabetes Center (IDC).

More than 300 patients walk through the doors of the main center in Minneapolis each month, most of them as participants in the IDC’s six-month diabetes education program.

"It’s designed to show results," says Patti Rickheim, MS, RN, CDE, manager for patient education at the IDC.

And it’s working.

A random sample showed the average group of patients began with a HbA1c of 9.5%, and that dropped to 7.2% by the end of the program.

IDC uses the team model to work with primary care physicians, internists, and family practitioners. The team includes nurses, dietitians, and psychologists — 90% of them certified diabetic educators.

"We consider ourselves part of their team," Rickheim says. Physicians within the IDC’s system of 13 satellite clinics and a central location refer patients for diabetes education.

Learning by repetition

The basic program for newly diagnosed Type II diabetics is focused on models for the adult learner. "They learn by doing repetition and seeing results and by basing their information on their experiences," Rickheim says.

"They need to have knowledge in order to make change, but they also need to see results. We’ve designed the sequence of the stages of the visits so that as adult learners they can learn something and then practice it and come back and see results of what they’ve done," she explains.

In the first two visits, patients are seen both in group and individual settings. They are given basic information about diabetes, and the point is driven home that "diabetes is a serious disease, and we let them know they can manage it," she says.

Patients are taught to do glucose monitoring and asked to test every day for two weeks until the next visit. They work on a meal plan and keep a diary.

"Interestingly enough," notes Rickheim, "they have made some really keen observations about how their body works based on their blood sugar. It’s helping them understand how their body does respond to food and to exercise. Patients begin to see that certain things do make a difference, that even small changes can make a difference in their blood sugar.

"We’ve designed our program to provide certain information and content at different visits, so we have sequenced the learning based on research models," Rickheim explains.

Programs are also available for those newly started on insulin and for maintenance of previously diagnosed patients.

The last two visits for Type II patients delve more deeply into applying the knowledge to everyday life. "We work with them to make behavioral changes along the way," she says. "It’s a lifestyle change they must make since diabetes is a chronic disease. They aren’t going to make it in one visit or because they’ve learned something one time."

Motivating and encouraging patients

Information is fed carefully to patients as they are ready to assimilate the knowledge.

"They need to be encouraged. We see ourselves more as facilitators who work with the patient with the goal of empowering the patient to make their own choices and decisions but with providing them with information, suggestions, or feedback so that they will be more successful," says Rickheim.

Along the way, staff maintain close touch with primary care physicians to make recommendations in terms of behavioral and drug therapy.

Medication adjustments are frequently made, including insulin adjustments after telephone monitoring. "There is a fair amount of latitude. Our physicians are quite confident in the work we do; they pretty much leave it to us to make insulin changes and such," says Rickheim.

In addition, IDC is working on a plan to intensify management by closer monitoring of comorbidities. Many IDC patients have hypertension and lipid problems, so the staff not only discuss complications with them but are preparing the next phase, to review patient records and generate referrals for lipid testing, eye exams, microalbumins, perhaps even automatically generating pre-authorized lab slips and returning results to physicians.

Rickheim’s advice to diabetes educators: "Look at outcomes and look at overall goals and plans. Keep in mind that more is not better. Sometimes simpler is better.

"What is the need-to-know information? Sometimes it’s too much, and even adults can’t take it all in. We want to give them the tools where they can make change and be successful because it is for life," she adds.

The IDC plans to publish its Type II curriculum in early 1999. The guide will walk patients and staff through each section, including the rationale, the research, and clinical information as well as explaining the reasons underlying the learning objectives. It will also provide suggestions to staff to address behavioral change.

To purchase copies of the IDC curriculum when it is published, contact Patti Rickheim, MS, RN, CDE, Manager for Patient Education, International Diabetes Center, Minneapolis. Telephone: (612) 993-3393.