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    Six Ways to Support Diabetic Patients with Their Treatment Plans

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    Patients with diabetes work very hard to manage their disease, says Elizabeth Seaquist, MD, professor of medicine at the University of Minnesota and endocrinologist with the University of Minnesota Health in Minneapolis. That’s why she refrains from using the word “compliance” when discussing patients’ success with their treatment plans.

    SeaquistSeaquist

    Seaquist describes diabetes management as “all consuming,” and she says continuous blood glucose monitoring devices can be a huge benefit to patients, despite their increased cost relative to glucose testing strips, because they are the easiest way for patients to determine their blood sugar levels.

    Her preference for wireless monitors underscores a critical element of diabetic patient support: Identifying ways to make self-management easier for diabetic patients. 

    Here are six other ways providers can help patients manage this daunting disease.

    1. Advise patients to eat like the athletes they admire.

    The biggest way to maintain control of diabetes is to eat properly, says David Klonoff, MD, clinical professor of medicine at University of California San Francisco and editor-in-chief of the Journal of Diabetes Science and Technology.

    Klonoff encourages patients to eat like athletes, such as the Patriots’ quarterback Tom Brady.

    Brady’s diet includes copious amounts of water, in addition to smoothies, fish, vegetables, turkey and chicken burgers, and salads.

    “We should probably all be eating this diet,” says Klonoff, who encourages patients to drink only zero-calorie liquids, such as water, coffee, and tea; even a little diet soda is acceptable.

        2.   Tailor medications to patients’ needs.

    Seaquist laments that some payers base their diabetes medication coverage decisions on cost and side effects, rather than on what works best for patients.

    Some of the newer diabetes medications, which are more expensive than older treatments, only need to be taken once a day or once a week. Thus, these treatments are more likely to be embraced by patients, particularly when adhering to treatment plans has been difficult in the past, she says.

    Providing patients with access to daily or weekly medications will help keep them out of the hospital and can prevent them from experiencing complications, says Seaquist. “[Hospital admissions are] very costly. Well-controlled blood sugar is cost-effective and worth it.”

        3.    Assess patients’ “distress level.”

    Pavan Chava, DO, senior physician section head of endocrinology at New Orleans-based Ochsner Health System, says that while many patients with diabetes suffer from depression, others are suffering from “distress.” The source of that distress, which could be related to their interaction with their physician or financial or emotional concerns, is assessed by Ochsner’s diabetes educators who are dieticians, nurses, or social workers.

    A patient’s distress is determined by a series of questions. Responses are ranked from 1—or “not a problem”—to 5—for “a very serious problem.” Some of the questions include:

    • Do you feel overwhelmed by the demands of living with diabetes?
    • Do you feel that you’re often failing with your diabetes routine?
    • Do you feel angry, scared, and/or depressed when thinking about living with diabetes?
    • Do you feel that your doctor doesn’t know enough about diabetes and diabetes care?

     

    ChavaChava

    Diabetes educators can use the responses to connect patients with the appropriate resources, says Chava. The educators connect patients unable to afford medications to financial counseling and provide them with referrals to nonprofit organizations and pharmaceutical companies that can provide discounted medications. They connect patients experiencing emotional difficulties to psychiatrists or psychologists.

    When a patient’s distress is related to their physician, the physician receives that feedback. Often, having awareness, helps, says Chava, who supports coaching physicians with motivational interviewing techniques.

        4.   Educate patients on appropriate types of exercise.

    Many patients with diabetes don’t know the appropriate workout regimen, says Klonoff. For example, overweight patients with diabetes should refrain from running outside or on the treadmill, which is bad for their knees and hips. Better alternatives for these patients include the elliptical machine, bike riding, and swimming, he says.

    Just as important is educating patients about managing their disease while they’re working out, says Seaquist. That’s because patients always need to know the status of their blood sugars, which is another reason she recommends continuous glucose monitoring devices. When a patient is working out on an elliptical machine, it’s very difficult to take out a testing strip and test blood.

        5.   Facilitate dialogue and support among family members.

    Eating food can be a communal or even a spiritual experience, says Seaquist. Take, for example, celebrating Ramadan, which requires Muslim observers to fast and then feast. Patients need to be able to cope with these scenarios—and family support can help, she says.

    Family members also need to communicate about ways to manage the disease as a family unit. As with managing any chronic disease, this requires a family member with diabetes to discuss the best way to communicate about their condition, says Seaquist. “Some people are thrilled to have someone else take care of them all the time. Other people are more independent and only want their spouse to interfere if there’s a dangerous situation.”

        6.   Increase support for patients suffering from loneliness.

    EapenEapen

    Zubin Eapen, MD, system chief medical officer at Cerritos, CA-based CareMore, a health plan and healthcare provider, which is an Anthem subsidiary, says that many of its seniors live alone and experience loneliness. In response, CareMore developed the Togetherness Program, which matches employee volunteers in clinical or administrative roles to patients experiencing loneliness.

    These relationships are sustained by regular phone calls, as determined by patients’ needs; some patients receive phone calls as often as once a week, says Eapen. The program, which serves all patients—not just those with diabetes—provides them with a social outlet. CareMore also learns more about patients’ needs because of these ongoing interactions.  

     

     

    Aine Cryts is a writer based in Boston.

    Aine Cryts
    Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, ...

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