Medicare Diabetes Self-Management Training Act

Floor Speech

Mrs. SHAHEEN. Mr. President, I rise today to talk about the Medicare Diabetes Self-Management Training Act, a bill I have recently introduced along with Senators Stabenow, Hagan, Franken and Landrieu. This bill will improve the lives of Medicare beneficiaries with diabetes by improving their access to high quality information and care from certified diabetes educators.

Diabetes affects many individuals and families in New Hampshire and across the country. My own family was touched by the disease in 2007 when my eldest granddaughter Elle was diagnosed with type 1 diabetes. We have experienced firsthand the challenges that diabetics and their families confront in having to continuously monitor and manage blood sugar levels, administer daily injections, and face a lifetime of worrying about the possibility of serious complications arising from the disease. Diabetes can be managed effectively but it requires a sustained coordinated team effort among patients and their health care providers. Certified diabetes educators, as defined by the American Association of Diabetes Educators, ``are licensed healthcare professionals who specialize in educating people with diabetes about their condition. The training, counseling and support that diabetes educators provide to patients is known as diabetes education or diabetes self-management training.'' This education teaches patients how to stay healthy, and the diabetes educator is an important part of the health care team.

Take for example a case from Raymond, NH. The patient, Rachel, is 45 years old and has type 2 diabetes. For years she struggled, trying to understand how her eating habits and lack of physical activity negatively impacted her diabetes and general health. Her medical provider followed all the appropriate American Diabetes Association guidelines, tried several oral medications and insulin, but in spite of this, Rachel's diabetes remained poorly controlled. In fact, not only were her blood sugar levels elevated, but she was already starting to suffer from complications related to diabetes.

However, once Rachel began working with a certified diabetes educator, CDE, things started turning around. The CDE was able to assess and accommodate Rachel's individual learning style and barriers to change. Through ongoing support and positive reinforcement, Rachel began to recognize her ability to control her diabetes with a few lifestyle changes. Successful, long-term behavior change is difficult to achieve in the best of circumstances. One only has to look at the current obesity epidemic in the U.S. to appreciate the difficulty in learning how to eat healthily. Rachel's success in eating less and healthier and walking daily was due in large part to the relationship that developed between her and her diabetes educator. Rachel now understood the lifestyle changes necessary to achieve success and was able to bring her blood sugar into a safe range. She reported having more energy and was able to cut her insulin dose in half.

Over the years Congress has made strong efforts to improve the care of individuals with diabetes. This includes authorizing the diabetes self-management training, DSMT, as a Medicare benefit in 1997, with the goal of providing a more comprehensive level of support to educate beneficiaries about diabetes and self-management techniques, reduce the known risks and complications of diabetes, and improve overall health outcomes.

However, there is a significant gap in the 1997 DSMT benefit that holds it back from achieving its full potential. Under the DSMT, Medicare covers the critical types of health care services necessary for diabetes control, but does not recognize the health care professionals who deliver those services. Certified diabetes educators are the primary group of health care professionals who work most closely with the patient to provide essential training and education in diabetes self-management. My legislation is designed to address this gap by ensuring that certified diabetes educators are designated providers under Medicare for these vitally important services.

Under the Medicare Diabetes Self-Management Training Act, a certified diabetes educator would be a covered provider of Medicare DSMT services. This health care professional, who is State licensed or registered, is most typically a nurse, dietician, or pharmacist, who specializes in teaching people with diabetes how to stay healthy and who maintains rigorous certification and continuing education credentials. This bill also increases education and outreach to primary care physicians about the importance of DSMT for their patients with diabetes. I am proud to have introduced this bill along with my colleagues Senators Stabenow, Franken, Hagan and Landrieu.

Diabetes is an incredibly costly disease. It is among the chief contributing causes of adult blindness, lower extremity amputations, heart disease, periodontal disease, kidney disease, vascular disease and infections. There is no cure yet but with the proper tools it can be well managed and complications can be prevented. I believe this bill is an important step along that path. I urge my colleagues to support this important cause.

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