Making Your Life Easier for Diabetes Management and Your Patients More Independent

By: Debbie Hinnen APN, CDCES, BC-ADM, FAAN, FADCES – University of Colorado Health, Colorado Springs, CO

Does it feel like you are pushing the boulder uphill with some of your diabetes visits? Your patients with diabetes have a self-managed disease. If they see you for a (generous) 30-minute visit 4x/year, that is 2 hours of guidance and coaching. But they can’t take you home with them. And that leaves about 8,758 hours that they are on their own.

To help PWD (People with Diabetes) be as independent and self-sufficient as possible, please refer and INSIST that they complete comprehensive diabetes self-management education and support (DSMES). This is more than an appointment with the dietitian. Some of my colleagues tell their patients they are “in the boat together and they have to row too”. Some of my colleagues say to their patients they won’t help manage their diabetes UNLESS they complete comprehensive diabetes education.  

You want your patients to know the value of glucose monitoring, lifestyle adjustments with diet and exercise, new medications, sick day management, and what they are up against with the complications of diabetes out of control. They need care partner support and to be with others who have diabetes.

Threatening people with insulin injections if they don’t “comply” is not a successful strategy. 

Labeling them non-compliant transfers over unconsciously into your visit. PWD have barriers that are complex and time-consuming. Diabetes education is not just about KNOWLEDGE, but about Behavior Change and identifying issues that get in the way of diabetes management.

You want better outcomes and quality of life for your patients, and diabetes education provides that as well as lower health care costs. 2

Clinicians have barriers too:

Q. Will my patient be returned back to my care?

A. YES, your referral can be for Diabetes Education ONLY

  1. It costs too much for my patients. They tell me they can’t afford it.
  2. At the beginning of the year, there is a deductible for everyone, regardless if it is medication, co-pays for your clinic visits, etc. This is a life investment.
  3. Most programs have a payment program. Or a cash price. Or even scholarship funds to help make it affordable.
  4. AND most all insurance companies follow Medicare coverage policy. Ten hours is covered for comprehensive education and then 2 hours every year thereafter for refresher education AND 2 hours of medical nutrition therapy.


I don’t know who the diabetes educators are in my area or where the programs are located. 

A. Find a diabetes program and/or educator.   

Find a Diabetes Education Program in Your Area (

Find a Diabetes Education Program | ADA

The American Diabetes Association recommends four important times to refer for diabetes education.1

  1. At diagnosis
  2. Annually
  3. When there are diabetes changes; new medication, complications, diabetes distress
  4. When there are life changes; insurance change, living situation/care partner changes, etc

Diabetes education and medical nutrition therapy have a positive impact on improving A1C, morbidity, and mortality2. Our clinic has documented a greater than 1% drop in A1C for program completers. 

Analysis of multiple studies document A1C reduction of 0.45-0.57% 2

Consider the diabetes education referral as important and the metformin prescription and the foot exam.

There is a virtual team out there willing and ready to help you and your patients with their diabetes.



  1. Standards of Medical Care in Diabetes. Diabetes Care 2021 Jan; 44 (Supplement 1): S226-S232. Diabetes Association
  2.  Powers M, Bardsley J et al. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Educ. doi: 10.1177/0145721720930959. Epub 2020 Jun 8

See Debbie Hinnen APN, CDCES, BC-ADM, FAAN, FADCES speak at the GAPA 2021 CME Conference.

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