Alyce Thomas is a nutrition consultant in the Department of Obstetrics and Gynecology at St. Joseph’s Regional Medical Center in Paterson, NJ. Her passion is working with high-risk pregnant women, especially those with diabetes. Her interest in Diabetes Care and Education (DCE) began when she became the Academy of Nutrition and Dietetics’s Professional Issues Delegate liaison to the Dietetic Practice Group. Being impressed with DCE’s organization and dedication to its membership, she accepted the position as assistant editor for On the Cutting Edge, DCE’s peer-reviewed newsletter and later became the editor.
Thomas has authored or coauthored several publications on diabetes and pregnancy, including the Academy’s Guide to Gestational Diabetes Mellitus and the accompanying CD-ROM client handout, as well as the diabetes and pregnancy chapters of AADE’s Diabetes Self-Management Education. She was the first recipient of the Excellence in Practice Award from the Women’s Health DPG, and will receive DCE’s Diabetes Educator of the Year Award at the 2014 FNCE in Atlanta.
Thomas and her husband, Lee, live in New Jersey and are very active in their church. Her favorite location for rest and relaxation is Hilton Head Island. In recognition of National Diabetes Month, Diabetes Self-Management recently spoke with Thomas about her practice and what diabetes education means to her.
What drives your commitment to diabetes care and education?
I would not classify my commitment as a drive, but rather a passion to help improve the outcome of any pregnancy complicated by diabetes – which is, a healthy mother and baby. In the last 34 years, since I’ve been a registered dietitian, there has been a steady decline in perinatal morbidity and mortality in women with diabetes, which I believe is primarily due to the advancement in diabetes care and education. However, pregnant women with preexisting diabetes continue to have poorer outcomes than their non-diabetes counterparts, so we still have a ways to go with continual research and the expansion of diabetes self-management education.
How did you end up focusing your practice on pregnant women with diabetes?
I was fortunate to have completed my dietetic internship at the Montreal Diet Dispensary in Montreal, Quebec, whose focus was improving the outcome of pregnancy with intensive nutrition therapy and counseling. This was my first exposure to pregnant women with diabetes; I noticed that although we could improve their eating habits, their outcomes were far worse than other high-risk pregnant women. I did not realize back in 1976 that preconception counseling is one of the major keys to decreasing the risks to the mother and child, and should begin from puberty. It wasn’t until after moving to the United States that my focus moved toward pregnant women with diabetes, from preconception through postpartum.
Do you have strong bonds with other diabetes educators? What do you learn from them?
No one is an island unto themselves, and that is doubly true for any diabetes educator. Gone are the days when a health-care professional could practice in a vacuum. We need each other because we learn from each other, which makes the multidisciplinary team so vital to diabetes management. Although I work mainly with pregnant women, I have fostered relationships with other diabetes educators to find out what works and what doesn’t work in their practice. I learned a long time ago: Don’t waste energy trying to reinvent a wheel… instead, try to figure out how to improve it.
How have you seen diabetes care and education change throughout the course of your career?
Diabetes self-management education has been the major change in the diabetes practice that I have seen during my career. Gone are the days when we used to think we knew what was best for the patient, even if the treatment did not fit into her lifestyle. Now with the patient as an active participant in her diabetes management, coupled with outcome measurements, diabetes care and education has been shown to result in improved overall care and lower health-care costs. And we cannot forget how evidence-based diabetes education has resulted in improved decision-making regarding patient care.
What traits make a good diabetes educator?
Not only do you need the knowledge and skill sets to be a good diabetes educator, being an active listener is one of the most important traits. What the patient or client says – verbal as well as nonverbal cues – will assist the diabetes educator in providing effective care. Other traits of equal importance include becoming culturally competent and recognizing the importance of health literacy. You must also possess a passion for what you do.
How can the industry get more medical professionals to go into diabetes education as a career path?
I believe that the industry has to go beyond what is considered the “diabetes community” so that other medical professionals become interested in diabetes education. As an example, most pregnant women will seek their care from obstetricians, and I would venture to say the majority of obstetricians have not been trained in or are familiar with diabetes education. Since the prevalence of pregnant women with diabetes, whether preexisting or gestational, is increasing, the industry must be willing to develop relationships with obstetricians and gynecologists, who may not be aware of diabetes self-management education programs in their practice area. This may in turn cause their nursing and other health-care professional staff to become more interested in diabetes education.
How do you cultivate trust and a relationship with your patients?
I have been fortunate to work with obstetricians and maternal fetal specialists for most of my career. As a result, I have the opportunity to spend considerable time with every patient – often weekly – during their pregnancy. My training at the Montreal Diet Dispensary was invaluable; it taught me very early in my career the importance of treating the person and not only the symptom.
What am I saying here? I must see the woman as more than a “diabetic.” She is a woman with a health condition; there is more to her than diabetes. I want to know about her outlook on life. What does she want to talk about during her time with me? What if it’s not nutrition or diabetes related? It is during these conversations when I realize she may need to be referred to another health professional, or that the information shared with me may assist another member of the multidisciplinary team with the decision-making process. You have to be willing to not only think or go outside of the box, but sometimes throw the box away in order to establish patient relationships and trust.