[Congressional Record (Bound Edition), Volume 156 (2010), Part 5]
[Senate]
[Pages 7028-7029]
[From the U.S. Government Publishing Office, www.gpo.gov]




             MEDICARE DIABETES SELF-MANAGEMENT TRAINING ACT

  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

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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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