This post was written by Gerald Bernstein, MD, FACP, Director, Diabetes Management Program, Friedman Diabetes Institute at Mount Sinai Beth Israel.
It was the month of June 1959. I was in the last 30 days of my physician training internship, rotating through pediatrics. A 12-year old girl was admitted with type 1 diabetes mellitus. At that time, the only available tools for diabetes management were testing the urine for glucose and ketones. Other blood tests, including blood glucose, could take hours to perform. Insulin for injection consisted of mixed animal insulin (cows and pigs) and was much longer-acting and less predictable than the type we use today. The patient was a remarkable young woman and took things in stride.
Informal Teaching Was the Norm
Structured diabetes education did not exist, and any education came from the doctor or a nurse who would teach the patient about injecting insulin and testing urine, and give a rough idea about diet. An exception to this was at places like the Joslin Clinic in Boston, which was totally devoted to treating diabetes. Back in 1959, I sat with that young patient every day for about 30 minutes and told her everything I knew about managing diabetes, and then we would go over it again so she could gain a real grasp of the issues. I do know that 50 years later, she was well, had a family and was relatively free of major complications.
Diabetes Education Evolves
In the 1970s, the need for education became more apparent. In New York City, we had the New York Diabetes Association, which was an affiliate of the American Diabetes Association. We started education programs for patients, as well as for health care professionals. The goal was to make diabetes education more than a chit-chat. At the same time, a consortium of experts, including endocrinologists, RNs, nutritionists, podiatrists and others, was formulating an education syllabus for diabetes. In 1979, the National Institutes of Health and the Centers for Disease Control and Prevention established 12 Diabetes Research and Training Centers (DRTCs) for the syllabus to be used by the health care professionals to educate their peers. One was established in New York City at Albert Einstein College of Medicine, Montefiore Medical Center. It is still in operation.
Today, Structured Education Is Key
Today, the results of those efforts have lead to structured diabetes education all over the world. It is obvious that it is no longer something to be offered only to type 1 diabetes patients; all patients with altered glucose metabolism need to participate. In my mind, structured diabetes education is second only to insulin in importance for the diabetes patient. This kind of approach led to the development of the Friedman Diabetes Center at Mount Sinai Beth Israel and other centers like it around the country.
The appreciation of the role of education in diabetes management will help us in Part 3 of this series, as we look at how to neutralize the growing diabetes problem, especially in the face of new concepts in health care delivery.
To learn more about diabetes and the Friedman Diabetes Institute at Mount Sinai Beth Israel, please visit our website.