The Power of Diabetes Education and Clinical Support

Gaps in Diabetes Care Means That the Patients Have to Be Their Own Experts
(Part I in a Series)

In our recent blogs, we have emphasized the importance of early intervention and proactive care management for people who have been recently diagnosed with type 2 diabetes, especially since there are opportunities to reverse the disease or at the very least, improve future health outcomes.

The biggest challenge I feel for newly-diagnosed patients, as well as for all people with diabetes, is the lack of access to diabetes education and clinical support.

In our LivingConnected® program, for example, we have automated triggers that help us to intervene or reach out to patients who are having patterns of sustained blood sugars higher than 250 mg/dL or even patterns of persistent low blood glucose (BG) readings below 70 mg/dL. These triggers are aimed at targeting high-risk patients – and it is great that we can help these people, but we also we need to focus on other patients who fly under the radar.

We pay so much attention to those that are high-risk, that we fail to see the huge and lasting benefits of intervention and education at all stages of diabetes.

iStock-836052288 diabetes 101 on ylw legal padEarly education can result in preventing pre-diabetes from progressing to diabetes, reversing diabetes, or at the very least slowing down the progression. Most importantly, early education can also empower patients to feel that they do have some control over their diabetes.

By engaging these patients with more training and support, we can enable them to improve their diabetes health and prevent costly care requirements. Instead of going on insulin in two years, maybe they don’t have to go on it until ten years from now. 

As healthcare providers, we are trained to look at targets and goals, and figure out how to get our patients there. However, in treating people with diabetes, this approach may create a missed opportunity to help them improve their outcomes. For example, if a patient's HbA1c is below 7%, we categorize them as "well controlled" and do not tend to offer as much support, resources, education or training compared to someone who's HbA1c is above 9%.

Once someone has been diagnosed as "poorly controlled" we offer a slew of medications, medical devices, as well as education in an attempt to get them back to target ranges. What would happen if we treated everyone with diabetes as if they could always do better, and could always learn more?

Similarly, if someone has pre-diabetes, patients will say "I was told I was 'borderline'." Borderline means that if you don't do anything different than what you are doing now, then you will get diabetes. However, patients take it as "I don’t have diabetes yet, so I don’t need to worry about it right now."

We know that people with pre-diabetes are already over-producing insulin and their pancreas is working overtime to get their BG levels closer to target.

  • Normal fasting BG levels are below 100 mg/dL.
  • If you have diabetes, the targets (aimed at preventing long-term complications) for fasting BG are 80-130 mg/dL.

What happens if their blood sugar reading level is 130? Why is it that we don't consult with them or offer diabetes education just because they are in range?

Gaps in Care and Proactive Diabetes Management
All patients with diabetes should know about what specific gaps in care are and what can be done to proactively maintain and possibly improve their condition.

  • Patients need to understand specific targets and goals. Every patient needs to learn what their blood sugar targets are and what they should aim for to improve diabetes health.
    • Remember the fasting targets listed above, and if patients are checking their blood sugars two hours after a meal, a normal post-meal BG is under 140 mg/dL.
    • If one has diabetes there are varying recommendations:
      • ADA suggested BG below 180 mg/dL
      • AACE suggested BG is below 140 mg/dL
      • My recommendation to patients is: You definitely want to be less than 180mg/dL, but you should try to be under 140 mg/dL as much as possible.

  • Lifestyle education training must be a component in diabetes management. Although most physicians are aware that lifestyle changes can have a positive impact on their patient's health, a Certified Diabetes Educator could spend a whole hour with a patient to give counsel on critical next steps and best practices. 
    • Medicare will cover up to 10 hours of initial diabetes self-management training for patients in the first year. I cannot emphasize enough how important it is for patients to utilize this essential form of care to effectively manage and possibly reverse their condition. Diabetes health and outcomes can be improved at any stage of a diabetes diagnosis.

  • iStock-474923903 measurement of BMIIf blood sugars are within normal limits or "not that high," continuing poor lifestyle habits is not acceptable. Change needs to occur. As health care providers, we sometimes focus on treating only the "diabetes" and we fail to miss the bigger picture.
    • One patient of mine is obese with a BMI of 37 (she is 5'10 and 260 lbs). At her last check-up, her Hemoglobin A1c was only 6%. Since this is viewed as "under control," her doctor told her to "keep doing what you’re doing." She takes Janumet daily which helps to control BG levels, however, given her obese status she could probably benefit from nutrition or lifestyle education. If she could lose weight, she may be able to reverse diabetes or at least control it without medication. There are chances for improvement that her doctor is not focusing on which could include a plan for getting her off the Janumet.   

Diabetes is a chronic condition in which the patient is the one making multiple decisions about their health on a daily basis. For this reason, we must educate and empower our patients to become the expert in their own diabetes.

Diabetes Management: Setting Goals

Alejandra Cordovez, RD, LD, CDE

Alejandra Cordovez, RD, LD, CDE

Alejandra Cordovez is a Registered/Licensed Dietitian, and Certified Diabetes Educator for CCS Medical and works actively with LivingConnected patients.

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