Perspectives on Diabetes Care

The ADCES Foundation partnered with the Certification Board for Diabetes Care and Education to offer a one-year postdoctoral fellowship opportunity to support the career of emerging leaders in diabetes care and education. The fellowship reinforces long-term goals by both organizations to build on existing research in diabetes care and enhance health outcomes for people with diabetes, prediabetes and other cardiometabolic conditions.

Dr. Julia Blanchette PhD, RN, CDCES was recently named the recipient of the fellowship to support her continuing work in financial barriers in emerging adults. Learn more about her work and what she hopes to accomplish over the next year.

Hi Julia. Thank you for joining us and congratulations on receiving the fellowship! Tell us a little about yourself. How did you become interested in diabetes care and education research?

Thank you, I’m so excited to continue my research in this area. My exposure to diabetes care and education specialists from an early age inspired my career choice. I was diagnosed with type 1 diabetes when I was seven years old by my family nurse practitioner, who had a secondary interest in diabetes care and education. Looking back, it was impressive that she caught the signs of diabetes before I was critically ill and supported my family in a way that was needed. Much of my pediatric endocrinology care was also delivered by a diabetes care and education specialist who empowered my family to not let diabetes hold us back.

When I applied for college, I knew I wanted to go into nursing and hoped to go into diabetes care. Throughout nursing school, I was eager to connect with patients living with diabetes and teach my peers about living with diabetes.

I also had exposure to pediatric nursing research through the SOURCE Undergraduate Research Scholar program at Case Western Reserve University. I felt a continued desire to improve healthcare outcomes through research and applying the evidence in clinical practice. I began thinking about integrating diabetes care and education into research before I even graduated with my BSN in nursing but was unsure which areas to specifically focus on.

The summer after I graduated with my BSN, I worked at a diabetes camp as the nurse for about 30 16-year-old adolescents. My eyes were opened to the psychological self-management barriers faced by adolescents and emerging adults with type 1 diabetes. Additionally, some of my own barriers navigating the healthcare system as an independent, emerging adult expanded my curiosity in improving the transition from pediatric to adult diabetes care. I realized that I could not deliver supportive care and education to this population without a deeper understanding of self-management barriers. This was when I decided to go for a PhD in Nursing Science with a focus on self-management barriers in adolescents and emerging adults with type 1 diabetes.

What will be the focus of your fellowship project and career development? 

The focus of my fellowship project will be to expand my dissertation research. My dissertation findings support financial stress and psychological factors as barriers to self-management outcomes in emerging adults with type 1 diabetes. Now that I have identified these barriers through a cross-sectional study, the next step is to further investigate and address these barriers to improve self-management outcomes. My fellowship project aims to further examine financial stress and self-management outcomes from a community based participatory action method and develop a financial toolkit intervention aiming to improve HbA1c, psychosocial (diabetes-related quality of life), and financial (financial stress), and transition readiness outcomes.

How do you see your research impacting diabetes self-care and management in young adults?

Emerging adults with type 1 diabetes face many self-management barriers, and as a diabetes care and education specialist, I’m always hoping for additional education and resources to provide this population. I have had countless emerging adults see me for diabetes education after lapses in health insurance, hoping for diabetes support, and many still have financial barriers even after obtaining insurance. These clinical observations are in line with my dissertation findings that emerging adults with type 1 diabetes have high financial stress levels, and 17% were uninsured. At the same time, many were on healthcare plans with high premiums.

I hope to understand if the pilot financial toolkit intervention improves clinical (HbA1c), psychosocial (diabetes-related quality of life), financial (financial stress), and transition readiness outcomes in a small sample of emerging adults with type 1 diabetes. If the study findings support improvements in these areas, the next step would be to expand the financial toolkit on a larger scale based on community feedback and participation.

How does community participation factor into your research?

A community advisory board will serve as an iterative process between the researcher (me) and the community member. It will include individuals in the diabetes community who offer different perspectives essential to developing the financial toolkit. Such individuals include the following: a provider with expertise in caring for underrepresented emerging adults with type 1 diabetes, a diabetes care and education specialist with expertise in emerging adult care, a parent of an emerging adult with type 1 diabetes, two emerging adults living with type 1 diabetes and an individual with expertise in insurance and financial resources. The members represent the greater diabetes community and can voice concerns and priorities to consider in developing the toolkit to ensure it is relevant, applicable, and meaningful to those who will be using it.

The barriers to diabetes care are even more present in underrepresented Black, Indigenous and People of Color (BIPOC) communities. It will be vital to include BIPOC participants in the development and testing of this pilot project, to understand their perspectives, include their voices and ensure the communities that need this support the most have practical and accessible resources.

Tell us more about your mentors Dr. Michelle Litchman, PhD and Dr. Nancy Allen, PhD.

I am honored that Dr. Litchman wanted to mentor me for this project as I am inspired by the direct impacts her research and advocacy have made on the diabetes community and the cost of insulin. When we started developing the project proposal for this grant, Dr. Litchman quickly introduced me to Dr. Allen. Dr. Allen has expertise in Community Advisory Boards and researching self-management barriers in underrepresented populations of people living with diabetes. Both Drs. Litchman and Allen have already provided me with great support and guidance to get this project going. I look forward to training with them and learning more from them.

Stay tuned over the coming year as we share more about Dr. Blanchette’s project. Help support future work with the Foundation at DiabetesEducator.org/Foundation.

ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

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HEALTHCARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit DiabetesEducator.org/Find.