The NYU College of Nursing's Nursing Faculty Practice (NFP), a nurse practitioner (NP) managed primary care practice, launched the Diabetes Care and Lifestyle Center (DCLC) for older adults on January 3, 2011. The DCLC, located in the Nursing Faculty Practice on the first floor of the NYU College of Dentistry, includes a comprehensive diabetes management and patient diabetes self-management education and training program (DSME/T). The American Diabetes Association has recognized the DCLC as a satellite of the NYU Langone Medical Center's Diabetes Self-Management Education Center (DSMEC).

DSME/T provides a unique diabetes education by incorporating a collaborative approach to patient care. Patients, families, and healthcare providers work together in order to achieve ideal diabetes self-management goals, building around knowledge acquisition, skill attainment, and behavioral strategies. This blueprint, combined with the short-term and long-term objectives provided by the DCLC, will allow patients to follow a detailed, realistic method for diabetes treatment and prevention.

There are approximately 500,000 adults in New York City living with diabetes, and 38 percent (195,000) are older adults. Another 33 percent of all older adults in New York City (900,000) face a high risk of diabetes onset, due to impaired fasting glucose, or pre-diabetes. As a result, the number of older adults affected by diabetes is projected to increase exponentially.

One of the main factors contributing to effective control of chronic and acute diabetes is patient understanding of and ability to manage this chronic disease. Patient education designed to develop diabetes self-management skills is key to maintaining optimal health. Access to DSME/T programs in New York City is limited; 18 sites currently operate throughout NYC's five boroughs, and none are strictly dedicated to older adult populations. This is noteworthy, for it shows that taxpayer dollars dedicated to Medicare and Medicaid—programs that help fund DSME/T—are being used inefficiently. Thus, not many older adults either with or at-risk of diabetes take the initiative to receive DSME/T. DCLC is geared toward filling this service gap.

This service gap, states the DCLC director, Dr. Kelley Newlin, assistant professor of nursing, is "related, in part, to a shortage of trained clinicians specializing in diabetes care, especially for the older adult. Accordingly, each year the DCLC will train a cohort of multidisciplinary clinical students from such disciplines as nursing, dentistry, medicine, podiatry, and social work, among other areas."

Historically, leading institutional diabetes care teams (IDCT) have included the University of Miami, Vanderbilt University, Albert Einstein College of Medicine, and Yale University. However, IDCTs have not focused on the older adult population, and do not include crucial social work services, such as the consideration of economic constraints. The NYU College of Nursing's NFP design aims to provide a reproducible, national Diabetes Care and Lifestyle Center model aimed at older adult diabetes self-management and interdisciplinary education.

Now, older adults in New York City will be able to receive a thorough assessment of their health status and have an algorithm of services developed specifically for each individual. They will have access to services including, but not limited to, diabetes treatment, nutritional advising, social work support, interdisciplinary training programs, and routine monitoring, evaluations, and systematic referral processes.

CHRISTOPHER JAMES