According to the Center for Disease Control and Prevention (CDC), more than 34 million Americans —1 in 10 people—have diabetes. Another 88 million—1 in 3 people—have prediabetes. Diabetes increases the risk of heart disease and stroke and can lead to other serious complications, such as kidney failure, blindness, and amputations of limbs. (And nurses are not immune.)
People with diabetes spend more on health care, have fewer productive years, and miss more days of work compared to people who do not have diabetes. In 2017, the total estimated cost of diagnosed diabetes was $327 billion, including $237 billion in direct medical costs and $90 billion in absenteeism, reduced productivity, and inability to work.
It is safe to say that diabetes is rampant in our society. As nurses, we play a vital role in diabetes education and management. Patient education is a common and daily task for nurses of all levels and settings. If you think about it, we spend the bulk of our time educating and, at times, dispelling misinformation.
As a nurse practitioner in primary care, diabetes is one of the chronic diseases that you address every day in the clinic. The NP has an opportunity to stand in the gap for our patients dealing with the diagnosis. What I would like to do over the next few points is highlight areas that nurse practitioners who manage diabetes can engage in to better serve and increase patient outcomes.
Gone are the days where we treat just the diabetes diagnosis. Research has shown us that to achieve glycemic control, the provider would need to consider and manage other comorbidities as well. Maintaining a normal blood pressure and lipid panel are vital to glycemic control. Taking a holistic approach should be a priority.
According to the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE), lifestyle therapies should be initiated and enforced throughout management of diabetes itself. When properly enforced lifestyle therapies are more effective than any medication we can prescribe.
As simple as this may be, it is easier said than done. The hustle and bustle of our day-to-day clinic can leave us short on time and I for one have been guilty of rambling off the typical spill of “eat healthy and exercise more,” but allow me to challenge us to avoid the path of least resistance and lean in to the needed education.
Patients do not know what we mean by “eat healthy and exercise more.” We need to spell it out for them. Fortunately for us, both the ADA and AACE have given guidelines to assist us. In addition to these guidelines, I put together an NP resource that outlines lifestyle therapy.
Goal setting allows for a person to clearly define a desired outcome and set up a path through interventions to achieve this outcome. Setting goals in diabetes management is crucial especially when you involve your patient. Patient “buy in” is high when patients view themselves as the responsible party and driving force in the care.
Partnering with your patient in goal setting allows you as the provider to see what is of high importance to the patient, while allowing you to express to them what is of high importance to you. Together, you can come to a happy median that both parties feel comfortable with, and thus translating into better patient outcomes
A common method used for effective goal setting is SMART goals and more recently SMARTER goals.
Make your goal specific & clear: Who, What, Where, Why?
Ex: I will see a 1% reduction in Hgb A1c in all my diabetic patients within a six-month period.
How much? How many?
Ex: I will see a 1% reduction in Hgb A1c in all my diabetic patients within a six-month period.
Attainable, achievable
Ex: A 1% reduction is highly achievable within a six-month period.
Realistic, reasonable
Ex: Is this goal realistic, relevant, or reasonable to the audience? Yes, an A1c is relevant to the diabetic patients in your practice and 1% reduction realistic and reasonable.
Time bound, Finite time limit
Ex: The goal's time limit is six months.
Evaluate the goal
Ex: Once the time limit has been reached, did you achieve the goal? Did you get the desired outcome?
Modify the goal when appropriate
Ex: Adjust any part of the goal for it to be achievable and realistic.
I created a SMART Goals Workbook that is good not only for your clinic but simple enough for patient use. I have found this to be a quite simple but effective way of planning a care management plan.
It is proven that people who have the knowledge and support to manage their diabetes are healthier than those who do not. When patients learn how to control their diabetes, they will save money and time, and assist in fewer emergency and hospital visits.
Knowing how and when to take medication and how to monitor their blood sugar will produce better outcomes. This can only happen if we empower our patients to take an active role in their diagnosis. Our goal is to partner with our patients and allow them to steer the boat. Diabetes management starts with the patient.
There is a prominent need for more providers to get involved and diabetes education and management. I hope this article offered some good tips to get you started, and if you would like more detailed resources check out my FREE NP Diabetes Starter Pack! It includes key cheat sheets and guides over the foundational diabetes topics.
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