Ann Constance, MA, RD, CDE

Ann Constance, MA, RD, CDE, did not set out early in her career to become a diabetes educator, but one of life's opportunities helped her realize that she was perfectly suited for such a career.

She will be honored for her special contributions when she receives the Diabetes Educator of the Year Award during Friday's General Session. The award, sponsored by LifeScan Inc., recognizes her dedication, innovation and sensitivity in patient care.

After Constance earned her bachelor's degree in dietetics and master's degree in exercise physiology from Michigan State University in 1987 and 1990, respectively, she began working at Marquette General Hospital, Marquette, Mich.

She admits that she didn't want to work in a hospital, but she thought a hospital environment would allow her to hone her skills.

"I was expected to cover diabetes education, and I found my background as a dietitian and exercise physiologist was perfectly suited for the diabetes arena. I saw how I could help make positive changes in clinical outcomes over a short period of time," she said. "That was reinforcing to me and my patients."

In 1994, Constance joined the Upper Peninsula Diabetes Outreach Network, where she served as the special projects coordinator. In 1998, she was named director of the UPDON, where she and her staff helped develop diabetes self-management training education in a 15-county region.

Although the Upper Peninsula is a large landmass, only 300,000 people live there. Compared to the rest of Michigan, the area has a higher percentage of Medicare recipients, people who are eligible but not necessarily on Medicaid, and uninsured individuals.

The area is also underserved in its supply of healthcare providers. Through the Stanford Chronic Disease Self-Management Program (CDSMP), UPDON has helped train about 50 peer leaders, who provide ongoing peer-to-peer self-management support for people with chronic health conditions, many of whom have diabetes. As a consultant, Constance is working with the National Council on Aging to help expand a diabetes version of the Stanford's CDSMP.

Her agency also created a diabetes care quality improvement initiative. An early evaluation of the QI program estimated that $1 million per year in hospitalization costs were saved. Because of that success, five additional outreach networks in Lower Michigan were formed in 1995. Those networks experienced similar positive results. Unfortunately, state budget cuts forced the closure of these five networks two years ago.

"Through our work and partnerships, enhanced diabetes self-management care is occurring in physician offices and home care agencies, where people now get foot exams, eye exams and A1C tests," Constance said. "From initial to follow-up visits, we have seen improvements in blood glucose levels."

Constance also is the co-author of two books. Her latest, Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Guide to Counseling will be published in the fall.

"We don't believe that there are non-compliant patients. We believe that there may be things that are getting in their way of making changes. They may be mental health issues, financial issues that interfere with their ability to purchase medications or family issues," she said.

Constance too has demonstrated a high level of involvement at the state and national levels, including as an AADE and Michigan Organization of Diabetes Educators board member, chair of each group's Advocacy Committee, and as winner of AADE's Legislative Leadership Award and MODE's Educator of the Year

Whether she's collaborating with peers or working to strengthen diabetes care in Michigan, advocacy is her focus.

"I work in the public health sector, and it's about engaging partners to take action on diabetes initiatives that has brought about any success I've experienced," Constance said. "I am excited to be recognized as Educator of the Year by AADE. I also recognize that I share this award with many groups and individuals who have worked with my colleagues and me to make a difference in diabetes care and outcomes in the Upper Peninsula of Michigan."