Managing Type 2 Diabetes: How to reach your patients

Currently, more than 29 million Americans-about 9% of the population-have diabetes, according to data from the United States Centers for Disease Control and Prevention.

Diabetes is a growing concern, and it has been estimated that the number of Americans living with diabetes will increase 64% to more than 53.1 million by 2025. Diabetes is considered a gateway disease; it can lead to a wide range of serious health conditions and complications, making effective management a crucial goal in the primary care setting.

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The total cost of diagnosed diabetes, as estimated by the American Diabetes Association (ADA), is $245 billion. This represents a 41% increase from the ADA’s 2007 estimate of $174 billion, and includes $176 billion in direct medical costs (such as prescription medications, office visits, and inpatient care) and $69 billion in indirect costs (including decreased productivity, increased absenteeism, disability, and mortality.) Patients with diabetes spend about 2.3 times more on healthcare, on average, than patients without the condition.

“Diabetes is a serious epidemic facing not only our nation, but the world,” says Marjorie Cypress, PhD, CNP, president, health care & education for the ADA. We need to work together to provide people with healthy ideas they can put into action.”

Primary care physicians can support patients in managing their diabetes by implementing the following tips and resources into their practices.

NEXT: Patient management tips

Patient Management Tips

Schedule regular visits.

Schedule patients with diabetes for four visits per year. Diabetes is a chronic disease that needs ongoing management, and it is very difficult to try to add chronic management of a complex disease when the patient is coming for a specific complaint.

If a patient comes to the office for a routine diabetes recheck and has a complaint, address it but reschedule the diabetes recheck. Studies have shown that the more visits committed exclusively to diabetes care the better the control.

Refer all patients for diabetes education.

While you may not provide this in your office, diabetes education will assist patients greatly in their self-management. This may save endless hours in problem -solving if the patient has a good base knowledge of the disease.

Encourage patient self-management.

Ask patients to check their glucose. This will enable you to protect your patients and give them the ability to problem-solve if their levels are running high or low.

For example, patients only on metformin can be asked to check their levels one to three times per week, while patients on sulfonylureas check more often. Patients should be reminded always to check their glucose level before administering a shot of insulin.

Establish a glucose meter download station.

This software is free and often provided by the meter companies. You can ask your patient to download in the lobby if the station is kept there or your staff can download the data before you go into the examination room.

Studies have shown that it takes more than 15 minutes to review data by scrolling the meter or looking at a written log, while reviewing a glucose pattern from a download can be done in less than two minutes. This will provide all of the data you need prior to seeing the patient.

Ask patients to bring their meter to every office visit.

This gives you the ability to see what the glucose readings are and allows you to discuss what contributes to high and low readings.

If patients bring in their meters, it is important that you take the time to review the readings and comment on them.

Consider an in-office HbA1c and urine micro albumin machine.

This equipment gives you access to point-of-care information that may also be a source of revenue for your practice. Many manufacturers will provide the machine for free if you purchase the cartridges, but a practice would need to run the machines enough so that the cartridges do not expire. Most primary care practices likely will have a large enough patient base such that running a sufficient number of tests every three months won’t be a problem.

Order non-fasting labs.

Fasting can be a significant barrier to getting labs done for many patients, especially if they are on medications that can lower their glucose levels. Many organizations now recognize that fasting is not necessary for lipid panels. This means you can order labs prior to the appointment so that you can review the results at the time of the office visit.

Establish themed visits.

One strategy is to focus each quarterly visit on a theme, such as immunizations and preventive care in the fall, nutrition and exercise in the winter, microvascular complication risk reduction in the spring, and cardiovascular risk reduction in the summer.

Congratulate your patients.

Remember that patients have to work hard to maintain control of this progressive disease, so remember to congratulate patients for the work they do. If they feel positive about their diabetes recheck they are more likely to return.

Remind your patients.

Remember, and remind your patients, that diabetes care is a marathon, not a sprint. Diabetes is a disease with peaks and valleys and if you can orient to the chronic care model, both you and your patient will be happier.