The American Association of Diabetes Educators (AADE) is an important organization that sets the tone for diabetes care across the board. Its newest president as of January is Florida-based Donna Ryan, a registered nurse and dietitian with a quarter-century of experience under her belt. She brings important knowledge of the glaring gaps in healthcare that exist for some of the poorest, underserved populations in rural and urban regions.
We're excited to have Donna in this role as the organization strengthens its peer support collaboration with the Diabetes Online Community (DOC), and equally excited to have had a chance to speak with her recently:
An Interview with AADE President Donna Ryan
DM) Hi Donna, do you have a personal diabetes connection?
DR) I don’t have it myself. My grandfather had diabetes and my brother was diagnosed in the month before he passed. So it’s in the family and it’s near and dear, even though I don’t always talk about that personal side of it.
We hear that when you were growing up you had a dream very different from being a diabetes educator… can you share more about that?
You can’t take the country out of the girl…. (laughs). From the time I was little, my dad always had motorcycles and cars. He owned the #7 racecar and had a driver, and every Friday night we’d go down to the Five Flags Speedway in Pensacola and watch the race. It was early NASCAR. That’s what I grew up around. When I was 10, I got a mini-bike, which in the '60s was a miniaturized motorbike known as a RUPP. And we’d race them. Being 10, I really thought I could do that (for a living) because it just didn’t enter my mind that it wasn’t a legitimate career path to race cars and motorcycles.
My dad is 82 now and I live next door, and my minibike is still there in my dad’s garage. And I still enjoy it. Of course, now I am in the trenches of diabetes education.
How did you get started in diabetes education?
I’ve been at this for more than 25 years now. I started out as a registered dietician working in public health in downtown Los Angeles, where there’s a very large Hispanic population with diabetes. That’s how I got my feet wet and piqued my interest in diabetes, with that mixed diversity of people. Then when I got some more miles under my belt, I went back to school for my nursing degree and Master's, working in some hospitals there in LA and gravitating toward diabetes when I realized that this particular condition required so much education and support.
Many times, it was overlooked and in the hospital settings we were focused more on the particular issue that brought them to the hospital in the first place. I really got hooked into taking care of people who came to the hospital for something other than diabetes, but we’d do things like hold their insulin and not really understand the disease process itself. Later I started working with endos and pump companies and got proficient in the technology with all my dietitian and nursing knowledge. I’ve been doing that since 1998-2000.
Where are you working now?
I’m currently in Northwest Florida, which is where I'm from, and we moved back here in 2010 to help take care of my parents. I serve as Director of Community Health for Sacred Heart and Providence Health Systems, and manage inpatient and outpatient programs at four hospitals with Ascension Health that are 350 miles apart on the Gulf Coast. We have a lot of rural areas. I came from LA where I know pumps and technology and a whole different environment, and got here and was very humbled with the level of poverty here. It’s more rural poverty compared to urban poverty. I’ve traveled to people’s houses to help with insulin pumps, or whatever case management task they need. There’s a lack of resources and really a lack of knowledge about their diabetes, about blood sugars and even on self-care in general.
How did you get involved with AADE?
When I was still in LA, I looked around and didn’t really see a lot of other nurses or professionals specializing in diabetes aside from endos. So I searched and found AADE in about 2000, and immediately was attracted to the level of passion and compassion the educators had. At that point, I wasn’t a Certified Diabetes Educator yet but I learned so much from online communities and going to local meetings. I had some really great nursing mentors who helped me start my career with AADE. I’m really a lifelong volunteer and people person – my family sometimes says I volunteer too much -- so I started volunteering at the local level with the American Diabetes Association, the JDRF and in hospitals that started support groups and classes.
With AADE, I think I’ve been in every volunteer position at every level they have – from the local and state levels to national committees and then the in-patient educator group, before joining the National Board. So it’s been about 18 years of learning and involvement and really just passion and excitement. There’s so much to learn, and it’s been a fulfilling career.
How is it going so far in the AADE presidency?
I’m two months into it, and didn’t quite understand how much I’d enjoy it until I started. You go through so much at all the other levels of volunteering, and you get to this national level and it’s like the 30,000-mile-up view. It’s really wonderful.
What are the biggest changes you’ve observed over the years with AADE?
That’s a great question. From my perspective, I am your typical member, but I’m also not because I’ve done West Coast, East Coast, rural and urban clinics, inpatient and outpatients. I have all these hats I’ve worn. But one of the biggest things that I’ve seen evolve, and is still in the forefront, is the evolution of the diabetes educator and their place in the healthcare system.
At last summer’s annual meeting, there was even talk about shifting away from the term “diabetes educator.” What might we expect to see on that front in 2018?
We started out with diabetes educators being mostly teachers, having a curriculum where they taught patients about medications and meters in a traditional model. Very quickly on, I realized that being a diabetes educator was more than having a curriculum and teaching. There’s advocacy, technology, being an expert and thought-leader in your community and hospital or healthcare setting. Many times when everyone’s at the table, it’s the educator who has the deep knowledge about whatever process or strategy or medication is being discussed. AADE has evolved with that, and we now have a broader scope and expertise than just education. Sometimes we get pinned with, 'It’s just education and a class, and I don’t need to take a class.' What we do is care and case management, navigation, decision-support, advocacy, working with pharmacy specialists, and so much more. I’ve seen that expand through the years.
We are currently in a visioning process, doing our best to envision what the healthcare practice will look like going forward and creating a roadmap. We are now identifying our potential as diabetes educators not just in the next 3-5 years, but the next 10-15 years. Where and how we can expand our expertise and scope with chronic disease for what people need from us?
What’s been the most eye-opening experience for you with AADE?
For me, it’s about being amazed at how much is available (for people with diabetes), but also how much is not available. There are so many meds and knowledge and technology, and overall healthcare resources, but it doesn’t always make it to the person with diabetes. So that’s been a wonderful opportunity and big challenge, to help make that happen for people who are dealing with language, economic, behavioral, transportation or other types of barriers. All the good stuff in the world doesn’t help if you can’t get it to the people who need it the most.
Yes, access is so critically important! How do you believe AADE can address that?
I see that as our mission. We have to be champions and catalysts, connecting people with the resources they need most in order to live and manage their diabetes. It’s easy to write a prescription and say 'Take This,' but there’s so much more to it in making that relevant to a person’s life. It’s life-changing.
Can you share more about your professional work helping poorer, underserved populations?
Whether you’re on the East or West Coast and urban or rural, the Standards of Diabetes Care and Education don’t change. The pharmacology doesn’t change. But what I learned in moving through the different areas of diabetes is that the way they’re adapted to the local population varies greatly.
It seems like I’ve always worked in the poor, impoverished areas at some level. One of the things I learned very early on is critical is listening. If you don’t know where someone is coming from -- culturally, emotionally, where they are in their life’s journey – and they are sitting there with you talking about issues you think are important but they do not… you’re not reaching them.
That is such a key lesson, but one that many don’t seem to grasp. How did you learn it?
One of my first patients to teach me that was a pregnant woman with gestational diabetes, who didn’t speak English and had two or three other children with her at the appointment. We were going through everything with an interpreter, because my Spanish wasn’t too good then. She very quietly sat and listened and participated for about 30 minutes, with me going through everything I thought I was supposed to. At the end of it, she asked a question and the interpreter’s face went white. The interpreter looked at me and said, 'She wants to know where the morgue is.' We told her and asked why, and she told us that her 16-year-old son had been killed the night before in a drive-by shooting.
This lady sat with us for 30 minutes and listened to diet, insulin, and everything we were saying about diabetes. But that wasn’t the most important thing to her in that moment. To me, that was the key turning point. To always ask at the beginning of any 'education' session: 'What’s important to you right now? What do you need and what’s on your mind before we get started?' If you’re doing that, it doesn’t matter where you live or the situation you’re in, it comes back to the most important thing in a person’s life.
Wow, what a story! Thank you for bringing that perspective to AADE. To reach more underserved patients, we hear the organization will be working with a national truck driver’s association this year...?
Yes, the CDC awarded us grant money for the second year last year to focus the Diabetes Prevention Program on the poor and underserved who are at high risk for type 2 diabetes. We chose to focus on truck drivers, who have a very high rate of inactivity, sedentary behavior that leads to obesity and type 2. They are also very connected to their communication with radios while driving, especially their “Renegade” station.
So CDC awarded the AADE money to develop a diabetes prevention program for this population, and it’s a five-year grant to give them this education while they’re on the road. There’s also an interactive platform to use in conjunction with that at other times (when they’re not driving). We know we can reduce the onset of T2 diabetes by 54% with lifestyle, some diet and physical activity. That support part is important, because the more touch-points people have with their peers and healthcare team, the more sustained outcomes are in general. We’re excited about this program.
What are the big priorities for your term?
There are several focuses for 2018:
- Diabetes Ed Vision: In the first two months, we’ve been working hard on our visioning. By the end of the year, we’ll have an action plan for the vision of diabetes education and support going through to the year 2030, with a roadmap on how we fit into new models of care, how technology can be used to make an impact, how new models of D-education don’t fit into traditional care, as we look at value-based care and how it all fits together.
- Technology: We're now rolling out our new DANA mobile app and technology review platform, with enhancements coming in June. That will be more resources for members, to help them learn and have better access to info about technologies that will get them comfortable helping people with diabetes be successful. We’ll be taking competency to the next level. That also involves doing what we can to use population health data in ways that can inform how technology’s developed.
- Peer Support: I’m really proud of the work AADE has done in collaboration with (former AADE past president) Hope Warshaw and those in the DOC. That’s an area for our membership – and beyond into the healthcare team – to raise the awareness that there's evidence of outcomes that peer support communities provide. It's important to have that be part of our healthcare models for people with diabetes, to reach more people and sustain that support over time so diabetes care isn’t so episodic in just an office visit.
- Diversity: This goes along with the gaps that exist in diabetes and healthcare, and the obligation we have as diabetes educators to try to best represent the communities we serve. We are proactively developing a diversity task force group to work to better incorporate diversity and cultural competency into our membership, and get more people from different backgrounds to specialize in diabetes education.
What about current advocacy priorities for AADE?
We’ve moved beyond what we have done at the federal level for many years. Now, with (government relations specialist) Kurt Anderson leading those efforts, we’re focusing on state and local level advocacy. We're addressing diabetes education and management, along with affordability and access, to the issue of non-medical switching by insurance companies and suppliers. That’s a pretty aggressive advocacy platform for us.
Finally, what would you like to say to the Diabetes Community?
There’s a lot of work that’s already been done, but I look forward to building on that. Collaborating with people in the community is the best way to do that. We often don’t know what we don’t know in these collaborations, and working together going forward is the best way to bring real true deep understanding to quality care in diabetes. The more voices that we are sensitive to, and incorporate into our professional lives and strategic plans and resources, the better and more practical it will be for the community. We’re only as good as how much we can help people, so our goal is to have the best resources we can to help those who need it.
Thanks for taking the time to talk, Donna. We look forward to seeing what's next for AADE!