Melissa Wadolowski is a Registered Dietician at Jefferson Hospital, located in their New Jersey office. Since 2016, she has been caring for patients as an Outpatient Dietitian while working toward becoming a Certified Diabetes Care Education Specialist in 2020.
Completing many hours of real-life, experiential, learning has since earned her this title. Melissa is an expert in educating Diabetic patients, as well as, their loved ones on the appropriate treatment options. Her recommendations for lifestyle changes are not only doable for that specific patient but also make a huge impact on their quality of life.
Melissa Wadolowski strives to change diabetes care in a way that avoids the diagnosis, to begin with, and prevents the condition from deteriorating. She is hopeful that nutrition, along with the approach of her fellow healthcare workers, will offer a more well-rounded medicinal approach.
Melissa’s Background
Melissa: My name is Melissa Wadolowski. I actually go by Mel.
Interviewer: And where are you from specifically?
Melissa: I was originally born in Brooklyn New York and I grew up mostly in Long Island. I moved to Philadelphia in 2012.
Interviewer: What is your current title?
Melissa: I am a Registered Dietician and my state licensure is a Licensed Dietician Nutritionist. I am also a Certified Health Coach and most recently, I got my CDCES credential, which is Certified Diabetes Care and Education Specialist.
Certified Diabetes Care Education Specialist Eligibility Requirements
Interviewer: What are the requirements for Diabetes Training Certification?
Melissa: A person must have a particular certification already to be eligible. This could be a Registered Dietician, a Nurse, or a Pharmacist, and I believe there’s a Social Work and an Exercise Physiologist option. Once you’re certified in one of those areas, you must accrue 1000 patient hours of direct education related to Diabetes Care in order to take the exam. The Certified Diabetes Care Education Specialist exam is quite difficult, with a large body of information to know.
Interviewer: How did you complete the courses? Was it pre-COVID and were you doing it in person?
Melissa: I started my current job as an Outpatient Dietician for the Jefferson Hospital system in 2016. I’ve been keeping track of my hours in patient contact for Diabetes and earned 1000 hours last fall. My initial intention was to take the exam last winter, but, we were short-staffed. It ended up getting postponed to this fall.
Certified Diabetes Care Education Specialist Training and Coursework
Interviewer: What did that coursework consist of? Wondering if the Diabetes Care and Education Care Certification is a separate course load.
Melissa: There is not a separate course load. Once you’re already certified in one of those different specialties… Dietician, Nurse Pharmacist, that we discussed, you start to accrue your direct patient education hours. There’s also a continuing education component. Continued education can be completed through webinars and other online options and once completed, you’re eligible to take the exam.
Interviewer: In those four years, did you move in this direction towards Diabetes Coaching? Or was that something that you always wanted to do?
Melissa: I started initially splitting my time between two departments. One was the Nutrition Department, which was also previously Diabetes Care. The other department that I worked for was called the District Department. It was a statewide program that was emphasizing certain chronic conditions such as Diabetes and Hypertension in underserved populations. I helped with care coordination, answered patient questions, and provided education within the Nutrition Department.
Treating The Diabetic Patient
Interviewer:: Let’s talk about your patients generally. Is there anything that is similar between them?
Melissa: Probably a third of the patients I see are for Diabetes. A third is for weight management. The last third is more random. It might be something like chronic migraines, IBS, kidney disease, high cholesterol, and a variety of other different conditions.
Interviewer: Is there anything similar among the patients that you have that have been diagnosed with Diabetes?
Melissa: The vast majority of them are type two diabetes, and that’s related to metabolic lifestyle. I don’t believe we do a great job of educating people prior to when we start to notice metabolic changes or insulin resistance, which is seen 10 to 15 years before a diabetes diagnosis. Unfortunately, by the time I see a lot of my patients, they could have already made lifestyle changes and avoided being where they are.
Diabetes Care Patient Programs
Interviewer: What is a program you might put someone on when they come into your office with diabetes?
Melissa: A lot of that is patient-directed because not everyone will be in the same place. Not everyone will be ready for the same changes nor will they have the same accessibility to different foods. Much of that requires me to speak with someone to figure out the most effective changes that they’ll be able to put in place. And primarily, that does include a lot of dietary changes, reducing processed foods and sweetened beverages. It’s changing the focus to nutrient-dense foods that are high in fiber and learning how to balance carbohydrates so that blood sugar is not constantly on a roller coaster. But it takes more than just dietary changes. Stress management, adequate hydration, and physical activity also play a part in metabolic function and insulin resistance.
Diabetes Prevention
Interviewer: I imagine that Type 2 Diabetes reduces your mobility quite a bit in later years.
Melissa: And the thing is it doesn’t have to. One of the frustrating things is that Diabetes Care is complicated and multifactorial. In a doctor’s visit, doctors see a very high patient caseload. There’s rarely time to go into a lot of the pathophysiology, the lifestyle goals, etc. The patient will hear “eat better or do some exercise, and here’s a medication.” That often seems really inaccessible, or it’s so vague that its patients don’t know exactly what that means.
Interviewer: Do you think doctors are getting better?
Melissa: I think some doctors are getting better and are interested in this type of specialized nutrition care in the hospital system. I’ve definitely noticed we’re getting more referrals from doctors that are familiar with our department which is exciting.
Interviewer: What kind of a doctor is it mostly?
Melissa: We get referrals from our endocrinologists. But we’re starting to get more referrals from our general practitioners, and then sometimes specialists depending on the condition. I mentioned that I see patients sometimes for chronic migraines, and I happen to meet one of our migraine specialists at a presentation a couple of years ago who will refer her patients to me occasionally.
Who Receives Diabetes Care?
Interviewer: Are your patients of a certain age?
Melissa: I think the current policy is for ages eight and up,
Interviewer: Eight and up? Single digit eight?
Melissa: Pediatrics is a little bit more complicated. But with that, our department really does an excellent job talking to each of the Dieticians to establish their comfort levels with different conditions. I don’t tend to see very young children just because I don’t necessarily feel comfortable with that population. But I do occasionally get adolescent or high school patients that come in with a guardian. Unfortunately, a lot of our care is dictated by the insurance policy. Medicare specifically will only allow nutrition education for diabetes, or for end-stage renal disease. We would like to see people before they get to the place that could potentially prevent chronic illness.
Trends in Diabetes Care and Education
Interviewer: What are trends in Diabetes Care And Education that you see changing going forward?
Melissa: I’m really, really hoping that we see a trend toward supporting education and changes before a condition is diagnosed. I’m hoping that with this transition into virtual care, it can be more accessible for a larger population of people sooner.
Melissa: In an environment where we have access to so many supplements, exotic foods, and different diet plans, a lot of people overlook the simplicity of the most effective things because they’re not glamorous. Eating less processed, more whole foods, getting adequate sleep, learning how to manage your stress, moving your body, etc.
Up Next for Melissa Waldowski
Interviewer: Is there any particular line of study that you would like to kind of focus on or get into as time goes on?
Melissa: I’ve been really jazzed about Functional Medicine the last couple of years as opposed to a lot of Western Medicine. Western Medicine identifies body parts as separate issues and works to give medications that address symptoms. Functional Medicine looks at the body as a whole and works to address the root cause of an issue. I’m seeing this emerging more and more. For example, if you have a pebble in your shoe and your foot hurts, sure, you can take Advil and feel better. But why wouldn’t you just remove the pebble from your shoe?
Interviewer: Is it possible that one day you could be a Functional Medicine Practitioner?
Melissa: Yes. I’m thinking, it probably is a lot sooner than I anticipated. I’m very, very excited. I have looked into different training programs. Some of them are master’s programs and some of them are just online study modules.
Melissa: My experience as a Certified Diabetes Care Education Specialist has allowed me to be able to identify issues quickly and see a lot of patterns. It’s difficult without the guidance of a trained physician, or a course on Functional Medicine. I can tell patients to ask their doctor about something and potentially get some tests, but now I would like to know what those tests are exactly. What lab values am I looking at and who can I collaborate with so that we can provide care safely? Those are the next steps for me and I’m really excited about that.
