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    Joanne Rinker

    Purpose: The purpose of this study was to construct professional competencies for diabetes technology use in various care settings reflecting the mission of the Association of Diabetes Care & Education Specialists (ADCES). Method: ADCES... more
    Purpose: The purpose of this study was to construct professional competencies for diabetes technology use in various care settings reflecting the mission of the Association of Diabetes Care & Education Specialists (ADCES). Method: ADCES convened a core team of nationally representative diabetes technology experts to develop professional competencies specifically related to diabetes technology use. A modified Delphi methodology, which comprised 4 rounds, was used for consensus development among these experts. First, experts developed and arrived at a consensus on the initial draft of competencies. They also identified health care professionals and staff essential for effective technology integration in various diabetes care settings. A survey was completed by diabetes technology experts that are members of ADCES. Next, a multidisciplinary focus group was conducted to gain feedback. Finally, the edited competencies were distributed via survey for feedback by diabetes technology expert...
    Diabetes is among the fastest growing health challenges in the 21st century, impacting more than 463 million adults worldwide.1 The prevalence of diabetes has tripled over the past 2 decades, and by 2050, it is estimated to affect 700... more
    Diabetes is among the fastest growing health challenges in the 21st century, impacting more than 463 million adults worldwide.1 The prevalence of diabetes has tripled over the past 2 decades, and by 2050, it is estimated to affect 700 million adults.2 The increasing prevalence is driven by socioeconomic, demographic, environmental, and genetic factors; urbanization; and lifestyle changes.2 Over the next 25 years, global inequalities in diabetes care are projected to widen and affect middle-income countries the most.3 Factors contributing to these inequalities are undiagnosed diabetes and mortality due to limited access or lack of health care, misdiagnosis, hyperglycemia in pregnancy, a rise in the genetic predisposition for diabetes during childhood and adolescence, and an inability to access medications.3 The increase in diabetes cases and inequities are worldwide concerns given that $760 billion (USD), or 10% of global health expenditures, are spent annually on adults with diabete...
    Supplemental material, dci20_0023_Supplementary_rev2 for 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... more
    Supplemental material, dci20_0023_Supplementary_rev2 for 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 by Margaret A. Powers, Joan K. Bardsley, Marjorie Cypress, Martha M. Funnell, Dixie Harms, Amy Hess-Fischl, Beulette Hooks, Diana Isaacs, Ellen D. Mandel, Melinda D. Maryniuk, Anna Norton, Joanne Rinker, Linda M. Siminerio and Sacha Uelmen in The Diabetes Educator
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical,... more
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes.<sup>1,2</sup>
    Purpose The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). Method A Delphi method of consensus development was used,... more
    Purpose The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). Method A Delphi method of consensus development was used, comprising 5 survey rounds. Interprofessional diabetes specialty experts were asked to identify and rate trends and issues important to diabetes specialists on a global scale. Use of a 5-round Delphi process allowed diabetes care and education specialty experts to refine their views considering the progress of the group’s work from round to round. Results A total of 457 diabetes care and education specialists across the United States in various professions participated in the Delphi rounds to identify a final set of 130 competencies across 6 domains. Conclusion Use of the Delphi method as a consensus guideline helped to identify core competencies for diabetes care and education specialists, reflecting the knowledge and skills necessary to provide e...
    Purpose The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). Method A Delphi method of consensus development was used,... more
    Purpose The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). Method A Delphi method of consensus development was used, comprising 5 survey rounds. Interprofessional diabetes specialty experts were asked to identify and rate trends and issues important to diabetes specialists on a global scale. Use of a 5-round Delphi process allowed diabetes care and education specialty experts to refine their views considering the progress of the group’s work from round to round. Results A total of 457 diabetes care and education specialists across the United States in various professions participated in the Delphi rounds to identify a final set of 130 competencies across 6 domains. Conclusion Use of the Delphi method as a consensus guideline helped to identify core competencies for diabetes care and education specialists, reflecting the knowledge and skills necessary to provide e...
    PurposeThe purpose of this article is to present a framework for optimizing technology-enabled diabetes and cardiometabolic care and education using a standardized approach. This approach leverages the expertise of the diabetes care and... more
    PurposeThe purpose of this article is to present a framework for optimizing technology-enabled diabetes and cardiometabolic care and education using a standardized approach. This approach leverages the expertise of the diabetes care and education specialist, the multiplicity of technologies, and integration with the care team. Technology can offer increased opportunity to improve health outcomes while also offering conveniences for people with diabetes and cardiometabolic conditions. The adoption and acceptance of technology is crucial to recognize the full potential for improving care. Understanding and incorporating the perceptions and behaviors associated with technology use can prevent a fragmented health care experience.ConclusionDiabetes care and education specialists (DCES) have a history of utilizing technology and data to deliver care and education when managing chronic conditions. With this unique skill set, DCES are strategically positioned to provide leadership to develo...
    Diabetes is among the fastest growing health challenges in the 21st century, impacting more than 463 million adults worldwide.1 The prevalence of diabetes has tripled over the past 2 decades, and by 2050, it is estimated to affect 700... more
    Diabetes is among the fastest growing health challenges in the 21st century, impacting more than 463 million adults worldwide.1 The prevalence of diabetes has tripled over the past 2 decades, and by 2050, it is estimated to affect 700 million adults.2 The increasing prevalence is driven by socioeconomic, demographic, environmental, and genetic factors; urbanization; and lifestyle changes.2 Over the next 25 years, global inequalities in diabetes care are projected to widen and affect middle-income countries the most.3 Factors contributing to these inequalities are undiagnosed diabetes and mortality due to limited access or lack of health care, misdiagnosis, hyperglycemia in pregnancy, a rise in the genetic predisposition for diabetes during childhood and adolescence, and an inability to access medications.3 The increase in diabetes cases and inequities are worldwide concerns given that $760 billion (USD), or 10% of global health expenditures, are spent annually on adults with diabete...
    Purpose Technology is rapidly evolving and has become an integral component of diabetes care. People with diabetes and clinicians are harnessing a variety of technologies, including connected blood glucose meters, continuous glucose... more
    Purpose Technology is rapidly evolving and has become an integral component of diabetes care. People with diabetes and clinicians are harnessing a variety of technologies, including connected blood glucose meters, continuous glucose monitors, insulin pumps, automated insulin delivery systems, data-sharing platforms, telehealth, remote monitoring, and smartphone mobile applications to improve clinical outcomes and quality of life. Although diabetes technology use is associated with improved outcomes, this is enhanced when the person using it is knowledgeable and actively engaged; simply wearing the device or downloading an app may not automatically translate into health benefits. The diabetes care and education specialist (DCES) has a central role in defining and establishing a technology-enabled practice setting that is efficient and sustainable. The purpose of this article is to describe the role of the DCES in technology implementation and to demonstrate the value of diabetes tech...
    PurposeDiabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has... more
    PurposeDiabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has prompted the need to reexamine the knowledge, skills, and abilities necessary for diabetes care and education specialists in today’s dynamic health care environment. The purpose of this article is to introduce an updated set of competencies reflective of the profession in this dynamic health care environment. Diabetes care and education specialists are health care professionals who have achieved a core body of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of people with diabetes and related conditions. Members of this specialty encompass a diverse set of health disciplines, including nurses, dietitians, pharmacists, physicians, mental health professionals, podiat...
    Supplemental material, dci20_0023_Supplementary_rev2 for 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... more
    Supplemental material, dci20_0023_Supplementary_rev2 for 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 by Margaret A. Powers, Joan K. Bardsley, Marjorie Cypress, Martha M. Funnell, Dixie Harms, Amy Hess-Fischl, Beulette Hooks, Diana Isaacs, Ellen D. Mandel, Melinda D. Maryniuk, Anna Norton, Joanne Rinker, Linda M. Siminerio and Sacha Uelmen in The Diabetes Educator
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical,... more
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes.<sup>1,2</sup>
    PurposeThe purpose of this article is to present a framework for optimizing technology-enabled diabetes and cardiometabolic care and education using a standardized approach. This approach leverages the expertise of the diabetes care and... more
    PurposeThe purpose of this article is to present a framework for optimizing technology-enabled diabetes and cardiometabolic care and education using a standardized approach. This approach leverages the expertise of the diabetes care and education specialist, the multiplicity of technologies, and integration with the care team. Technology can offer increased opportunity to improve health outcomes while also offering conveniences for people with diabetes and cardiometabolic conditions. The adoption and acceptance of technology is crucial to recognize the full potential for improving care. Understanding and incorporating the perceptions and behaviors associated with technology use can prevent a fragmented health care experience.ConclusionDiabetes care and education specialists (DCES) have a history of utilizing technology and data to deliver care and education when managing chronic conditions. With this unique skill set, DCES are strategically positioned to provide leadership to develo...
    Purpose Technology is rapidly evolving and has become an integral component of diabetes care. People with diabetes and clinicians are harnessing a variety of technologies, including connected blood glucose meters, continuous glucose... more
    Purpose Technology is rapidly evolving and has become an integral component of diabetes care. People with diabetes and clinicians are harnessing a variety of technologies, including connected blood glucose meters, continuous glucose monitors, insulin pumps, automated insulin delivery systems, data-sharing platforms, telehealth, remote monitoring, and smartphone mobile applications to improve clinical outcomes and quality of life. Although diabetes technology use is associated with improved outcomes, this is enhanced when the person using it is knowledgeable and actively engaged; simply wearing the device or downloading an app may not automatically translate into health benefits. The diabetes care and education specialist (DCES) has a central role in defining and establishing a technology-enabled practice setting that is efficient and sustainable. The purpose of this article is to describe the role of the DCES in technology implementation and to demonstrate the value of diabetes tech...
    PurposeDiabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has... more
    PurposeDiabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has prompted the need to reexamine the knowledge, skills, and abilities necessary for diabetes care and education specialists in today’s dynamic health care environment. The purpose of this article is to introduce an updated set of competencies reflective of the profession in this dynamic health care environment. Diabetes care and education specialists are health care professionals who have achieved a core body of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of people with diabetes and related conditions. Members of this specialty encompass a diverse set of health disciplines, including nurses, dietitians, pharmacists, physicians, mental health professionals, podiat...
    Purpose The purpose of this study is to report a systematic review of reviews of evidence and gaps focused on in-person and technology-mediated diabetes peer support and its impact on clinical, behavioral, and psychosocial outcomes.... more
    Purpose The purpose of this study is to report a systematic review of reviews of evidence and gaps focused on in-person and technology-mediated diabetes peer support and its impact on clinical, behavioral, and psychosocial outcomes. Methods We conducted a systematic review of reviews in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Reviews published in English from December 1978 through December 2018 examining clinical, behavioral, and psychosocial outcomes were included. The search yielded 167 reviews that were examined for inclusion/exclusion criteria. Results Nine systematic reviews and meta-analyses meeting criteria were included. Findings suggest peer support interventions can have a positive impact on clinical (A1C, blood pressure, cholesterol, weight), behavioral (diabetes knowledge, being active, healthy eating, medication management, self-management, self-efficacy, empowerment), and psychosocial (social support, h...
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical,... more
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2). The prevalence of diagnosed diabetes is projected to increase in the U.S from 22.3 million (9.1% of total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of...
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical,... more
    Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2). The prevalence of diagnosed diabetes is projected to increase in the U.S from 22.3 million (9.1% of total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of...
    Purpose The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). Method A Delphi method of consensus development was used,... more
    Purpose The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES). Method A Delphi method of consensus development was used, comprising 5 survey rounds. Interprofessional diabetes specialty experts were asked to identify and rate trends and issues important to diabetes specialists on a global scale. Use of a 5-round Delphi process allowed diabetes care and education specialty experts to refine their views considering the progress of the group’s work from round to round. Results A total of 457 diabetes care and education specialists across the United States in various professions participated in the Delphi rounds to identify a final set of 130 competencies across 6 domains. Conclusion Use of the Delphi method as a consensus guideline helped to identify core competencies for diabetes care and education specialists, reflecting the knowledge and skills necessary to provide e...
    PurposeDiabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has... more
    PurposeDiabetes care and education specialists provide collaborative, comprehensive, and person-centered care and education to people with diabetes and cardiometabolic conditions. The implementation of the vision for the specialty has prompted the need to reexamine the knowledge, skills, and abilities necessary for diabetes care and education specialists in today’s dynamic health care environment. The purpose of this article is to introduce an updated set of competencies reflective of the profession in this dynamic health care environment. Diabetes care and education specialists are health care professionals who have achieved a core body of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of people with diabetes and related conditions. Members of this specialty encompass a diverse set of health disciplines, including nurses, dietitians, pharmacists, physicians, mental health professionals, podiat...
    Purpose The purpose of this study is to report a systematic review of reviews of evidence and gaps focused on in-person and technology-mediated diabetes peer support and its impact on clinical, behavioral, and psychosocial outcomes.... more
    Purpose The purpose of this study is to report a systematic review of reviews of evidence and gaps focused on in-person and technology-mediated diabetes peer support and its impact on clinical, behavioral, and psychosocial outcomes. Methods We conducted a systematic review of reviews in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Reviews published in English from December 1978 through December 2018 examining clinical, behavioral, and psychosocial outcomes were included. The search yielded 167 reviews that were examined for inclusion/exclusion criteria. Results Nine systematic reviews and meta-analyses meeting criteria were included. Findings suggest peer support interventions can have a positive impact on clinical (A1C, blood pressure, cholesterol, weight), behavioral (diabetes knowledge, being active, healthy eating, medication management, self-management, self-efficacy, empowerment), and psychosocial (social support, h...
    Purpose Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty’s guiding documents for initial and ongoing support. It also defines various types... more
    Purpose Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty’s guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide. Conclusion Managing diabetes during the sta...
    Purpose Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty’s guiding documents for initial and ongoing support. It also defines various types... more
    Purpose Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty’s guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide. Conclusion Managing diabetes during the sta...
    Purpose The American Association of Diabetes Educators conducts the National Practice Survey (NPS) biennially to document current practice in diabetes education in the United States. The purpose of the study is to obtain insight about... more
    Purpose The American Association of Diabetes Educators conducts the National Practice Survey (NPS) biennially to document current practice in diabetes education in the United States. The purpose of the study is to obtain insight about factors influencing the work of the diabetes educator. Method The 2017 NPS was comprised of 100 questions covering diabetes educator demographics, profile populations of people with diabetes, practice information, program accreditation, program curriculum, staffing, education delivery methods, data collection, and reporting. The basic survey consisted of 22 questions using branch logic, from which respondents were then directed to questions tailored to their particular practice setting, enabling them to answer only a relevant subset of the remaining questions. The web-based survey was sent to approximately 32 000 individuals who were either members of the American Association of Diabetes Educators (AADE) or Certified Diabetes Educators (CDE) with the N...
    Self-management education is such a critical part of diabetes care that medical treatment without it is considered inadequate. This article discusses the North Carolina Diabetes Education Recognition Program and calls for expansion of... more
    Self-management education is such a critical part of diabetes care that medical treatment without it is considered inadequate. This article discusses the North Carolina Diabetes Education Recognition Program and calls for expansion of this program through local health departments.
    Healthy North Carolina 2020 is the state's health improvement plan, which has 40 objectives focused on making North Carolina a healthier state. Communities in the state have identified health priorities aligned with those objectives,... more
    Healthy North Carolina 2020 is the state's health improvement plan, which has 40 objectives focused on making North Carolina a healthier state. Communities in the state have identified health priorities aligned with those objectives, and the Center for Healthy North Carolina is helping these communities implement evidence-based strategies to address their goals.