Molly-Jayne Bangert, BSN, RN, CDE,working in the rural SouthwesternUnited States, is passionate aboutincreasing diabetes awareness andreducing risks associated with diabetesand pre-diabetes
In urban versus rural areas, what are thedifferences you see in the incidence ofdiabetes?
The incidence of diabetes and (maybemore critically) pre-diabetes in our ruralcommunities appears to be more than thenationally reported averages. We have familieswith several generations living in the samecommunity, and more and more of them arehaving diabetes in two and three “living”generations. Since families are often moreclosely connected in rural areas, it is importantthat we focus on family interventions, as theywill make a huge difference immediately andin the long run.
What challenges does a diabetesprofessional face when managing someonewith diabetes in a rural area of the UnitedStates?
The single largest challenge is the lack ofresources that are committed to optimaldiabetes outcomes, including nurses whoare passionate about diabetes education,dietitians, physicians and mid-level providers.With only one fulltime certified diabeteseducator for my six-county region, the 8,000-square-mile geographical distance is alsoa barrier to people getting access to theeducation that is offered. We’re working totake education to those who need it, but it iswith considerable challenges.
You wear a pump yourself. What advantagesdo diabetes professionals with diabetes haveover those who don’t have the condition?
The advantages of [having had type 1 diabetesfor more than 27 years and also] wearing apump are that I can tell my patients that Itruly understand what I’m asking them todo, as I strive daily to practice what I preach.Whether it’s carb counting, checking BGlevels or managing stress, my personalstories of successes and challenges oftenhelp them to understand they are not alone,and that it is a journey of improvement, notalways perfection. I’ve been able to sharewhat my choices have provided me and alsocost me over time. What I share with themin “educational” information is often notvery different from what other providers oreducators will tell them.
What does it take to be a good diabeteseducator today?
Other educators may define this differently,but for me, I believe that as a certified diabeteseducator, I must have integrity, respect andcommitment. Integrity in knowing that I giveinformation that is accurate for people to basetheir personal decisions on. Respecting theirchoices and readiness to learn and wherethey are in their change process. Committedto working with and supporting the healthychoices they do make. My commitment is tomake their educational experience personaland effective. I believe that life—with orwithout diabetes—isn’t about daily perfection.It is about consistency.
What is your impression of diabetes caretoday?
When provided as a team, it works! Manyprimary care givers don’t have or take enoughtime to provide even basic informationabout diabetes and other chronic diseases,nor do they stress the essential value andresponsibility of self-management or what Icall empowerment.
In the era of obesity and type 2 epidemics,how does diabetes education have to change?
Diabetes educators—and educators ingeneral—very early on need to be candidabout the consequences and risks of the extraweight. Helping people understand thatwhen we talk about obesity, it is a reference tohealth risks and not a personal judgment. I amfinding that more and more people are readyto make the therapeutic lifestyle changeswhen they fully comprehend what may likelyhappen (such as developing type 2 diabetesand its complications) if they don’t work tochange the habits that led them to wherethey are.