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Diabetes self-management training goes virtual for VA and Defense Department


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This year’s Education Recognition Program Symposium at the 81st Scientific Sessions will highlight innovation in patient-centered education for diabetes management from the Veterans Health Administration (VHA) and U.S. Department of Defense (DoD).

VHA and DoD Virtual Diabetes Self-Management Training (DSMT)—A Novel, Learner-Centered, Avatar-to-Avatar Remote Alternative for Providing Remote Certified Diabetes Education will feature a panel of speakers involved in the development of the Virtual Medical Center (VMC) and new training offered there by the U.S. Department of Veterans Affairs (VA). The session will begin at 8:00 a.m. ET on Saturday, June 26.

Brian V. Burke, MD, FACP
Brian V. Burke, MD, FACP

While the spotlight on remote health care delivery has brightened because of the COVID-19 pandemic, the expansion of virtual options is not new. The VA’s work on the VMC began in 2015. Within three years, pilot programs were underway for diabetes, weight, and sleep management. Then in 2019, financial support via the Joint Incentive Fund from the Health Executive Council was awarded to the VHA Specialty Care Services Diabetes Section and the U.S. Air Force Diabetes Center of Excellence in collaboration with the VHA Employee Education System (EES) to develop a DSMT program in the VMC. The funding also contributed a significant financial commitment for an upgrade to a cloud-based platform.

“We received funding, and then COVID happened and everything became much more urgent,” said Brian V. Burke, MD, FACP, Chief of Diabetes and Metabolism at Dayton VA Medical Center. “It created an opportunity out of a disaster.”

So far, more than 80 diabetes educators have received training through the VMC.

At its foundation, the VMC provides veterans and active-duty military personnel with a viable alternative to traditional face-to-face interactions when they are unable or choose not to make an in-person visit to a VA facility. Live classes are led by dietitians, nurses, and pharmacists every week. Through avatars, the trainers and students can gather at a virtual beach or other simulated locations.

Brian James, MEd
Brian James, MEd

“This platform allows learners to immerse themselves into a virtual world without leaving their homes,” said Brian James, MEd, Associate Director of eLearning for the EES. “This virtual world allows users to learn, connect with other veterans, and find information and answers in one location.”

He will explain the process that took the VMC from concept to implementation.

“Our primary motivation was access,” Dr. Burke said. “Virtually every guideline creator for diabetes says diabetes education should be front and center for all newly diagnosed patients, and ongoing through the lives of people with diabetes. It’s a chronic disease and we do a pretty miserable job at allowing people to get access to these services.”

It is estimated that fewer than 20% of people with diabetes receive self-management education, he noted.

The VMC is in the process of moving from a desktop application to a web-based delivery system, expanding access to all staff, veterans, and servicemembers with an internet-connected device, no matter where they are in the world.

Until the recent switch to the cloud-based platform, technology issues with downloading software created a barrier for some individuals. But overall, patient feedback has been positive. Many like the 24/7 convenience of virtual DSMT.

Mary M. Julius, RDN, LD, CDCES
Mary M. Julius, RDN, LD, CDCES

“Patients can go into the VMC asynchronously and receive evidence-based materials, so they’re not misdirected by misinformation on the internet,” said Mary M. Julius, RDN, LD, CDCES, National Quality Co-Coordinator for the VA/DoD VMC Diabetes Self-Management Training and Program Manager for Diabetes Self-Management Education at the Northeast Ohio VA Healthcare System. She will discuss training the VA’s diabetes educators to conduct virtual DSMT.

Her DoD counterpart is Stephanie Ansley, MS, RD, CSSD, LD, CDCES, Diabetes Self-Management Education and Support Quality Coordinator, Diabetes Center of Excellence, who will share information on the patient and caregiver experience with virtual DSMT.

“We had to change the culture,” Julius said. “We had to make diabetes self-management education available to our workforce and develop that workforce, helping them to first understand the definition of diabetes self-management education. It’s not that occasion titration. It’s more than medical nutrition therapy.”

Despite the success of the virtual offerings, in-person training is not likely to disappear any time soon.

“Nobody’s closing down face-to-face classrooms,” said Dr. Burke, adding that there continues to be a demand among patients and providers for in-person and hybrid programs. “As the technology grows, we’re excited about what can happen in the VMC combining those two modalities.”

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