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he dietitian's role in diabetes manage-ment is growing. In the future, dieti-tians will no longer be called upon

solely to evaluate diets, but to apply theirexpertise to manage the total care of aperson with diabetes and become an inte-gral part of the health care team. This isespecially true in light of the AmericanDiabetes Association's 1994 recommenda-tions, which stress a four-pronged approachof assessment, goal setting, nutrition inter-vention, and evaluation in the care of indi-viduals with diabetes (see articles on pp504 and 507). As a result of this growingrole, the Diabetes Care and Education(DCE) dietetic practice group (DPG) con-ducted a study to get a better view of itsmore than 3,000 members and how DCEwas meeting their expanding needs.

The studywas implemented by ResearchUSA, Chicago, Ill, in June 1993. A letter andquestionnaire were sent to 1,000 mem-bers; 623 questionnaires were completed.The following is a look at DCE membersand what the DPG means to them.

Diversity Is Spice Of DCE LifeMore than 9 of 10 DCE members who weresurveyed are currently employed in dietet-ics. These members work an average of 35hours per week in dietetics and spend anaverage of 15 hours per week in diabetescare and education. Two thirds of themhave 10 or more years of experience indiabetes care and education.

Most DCE members work with adultclients; a small percentage of memberswork with clients under the age of 21 years.The type of client most often seen bymembers are those diagnosed with type IIdiabetes associated with obesity; clientsleast often seen by members are womenwith type I diabetes in pregnancy.

Of those who provide patient education,70% work on an interdisciplinary team,which may include a registered nurse, phy-sician, social/psychosocial worker, or ex-ercise physiologist/physical therapist.

Members spend an average of 48% of anormal workday in individual counselingand an average of 8% of their time in groupcounseling. The rest of their time (44%) isspent in other work-related activities (eg,developing nutrition education materials).

Because DCE members have many pa-tients of a variety of ethnic backgrounds,

Lea Ann Holzmeister, RD, NetworkCoordinator, Diabetes Care andEducation dietetic practice group.

about half use ethnically specific diabetesnutrition education tools in patient educa-tion. The most common are Spanish orSpanish/English materials, and AmericanDietetic Association (ADA) booklets. Morethan half of DCE members have usedEth-nic and Regional Food Practice Series(1); Mexican American, Chinese Ameri-can, and Jewish are the most popular titles.

On average, the percentage of patientswith whom DCE members use variousmeal-planning approaches in diabetes nu-trition care is as follows: 54% use theExchange Lists (2), 29% use HealthyFood Choices (3), 12% monitor fat, 7%count carbohydrate, and 6% count calo-ries. These will all still be used as aspectsof the American Diabetes Association's1994 recommendations, but their applica-tion will be modified appropriately.

DCE members perform many differenttasks in their practices. Many develop nu-trition prescriptions, recommend specialtyfood products to clients, teach sick daymanagement guidelines, recommend ex-ercise activities/guidelines to clients, anddevelop diabetes nutrition education ma-terials.

Key To Their SuccessThe respondents to this study have beenDCE members for an average of 5 years.According to its members, the leadingreasons to join DCE include: primary areaof their practice is diabetes; the newslet-ters; the publications; and personal inter-est (Figure). The DCE newsletters,Newsflash and On The Cutting Edge,were viewed as the most helpful DCEresources. Members also appreciated thatDCE awards four educational stipends each

year to be used for attendance at a diabe-tes-related educational event, and presentsthe Distinguished Service Award, whichrecognizes exceptional leadership, and theCreative Nutrition Education Award, whichrecognizes creativity in educational mate-rials.

The projects members place the highestpriority for DCE to be involved in are theOn The CuttingEdge newsletter, the edu-cationmaterials (eg,HealthyFood Choicesand Exchange Lists), and nutrition prac-tice guidelines/standards of care.

DCE is the fourth largest DPG of theADA. The 1994 DCE program of work willinclude involvement in meal-planning pub-lications, revision of National Standards forDiabetes Patient Education, diabetes cost-savings studies, and an award that willallowa dietitian's camp-age client to attenda diabetes camp of choice for 1 week. ThisDPG is also very much involved in continu-ing education events (with the AmericanDiabetes Association and American Asso-ciation of Diabetes Educators), positionpapers for the Journal, and in federalhealth care reform as technical advisers.

For more information on the DCE sur-vey, write: Lea Ann Holzmeister, 2036 E.Red-field, Tempe, AZ 85283. ADA mem-bers can sign up for DPG membership ontheir membership renewal forms. Mem-bers with specific questions can contactADA at 800/877-1600, ext 4815.

References1. Ethnic and Regional Food Practice-ASeries. Chicago, Ill: The American Dietetic As-sociation.2. Exchange Listsfor Meal Planning. Alex-andria, Va: American Diabetes Association andChicago, III: The American Dietetic Association;1986.3. Healthy Food Choices. Alexandria, Va:American Diabetes Association and Chicago, ill:The American Dietetic Association; 1986.

JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / 497

Members' primary reasonsforjoining the Diabetes Care and Education(DCE) dietetic practice group.