According to the National Diabetes Statistic Report from the Centers for Disease Control and Prevention, there are more than 37 million adults in the United States who have diabetes, accounting for 14.7% of the adult population. Type 2 diabetes (T2D) is present in 90%–95% of individuals with diabetes.
Especially in primary care, where the majority of diabetes management takes place, an aging population with T2D and unequal disease incidence and burden in African American and Hispanic populations highlight key care considerations in successful disease assessment and management.
In order to help people with diabetes better grasp what it’s like to live with the disease, there is also a need for high-quality patient education.
Here are five things to understand regarding nonpharmacologic treatments for T2D.
1. Understand and treat the person before the disease.
The best health outcomes and quality of life for people with diabetes require a personalized care approach due to the complexity and recalcitrance of the disease.
Understanding the lived experience of the person with diabetes and how it affects self-care is essential to developing effective treatment recommendations, particularly for those from lower socioeconomic status and racial and ethnic minority groups, where diabetes disparities are greatest.
Over 90% of care is provided by the person with diabetes. Social determinants of health (SDOH) factors need to be evaluated, and policies addressing causative factors need to be adopted. These factors influence disease prevalence, cost of care, and disease burden.
The ability of a person with diabetes to effectively implement treatment recommendations, including access to new drugs, is directly impacted by SDOH elements, including the built environment, safety, financial situation, education, food access, healthcare access, and social support.
Person-centered care depends on the use of a shared decision-making process. Shared decision-making fosters an effective communication feedback loop, a therapeutic patient-care team connection, and a cooperative diabetic treatment plan between the patient and the care team.
Additionally, it encourages the development of a respecting relationship between the diabetic patient and the members of the care team. In order to effectively manage chronic diseases, a strong, transparent, and genuine collaboration must be fostered.
2. Quality diabetes education is the foundation for effective self-care.
A crucial part of diabetes care, diabetes self-management education and support (DSMES) ensures that patients have the information, abilities, drive, and resources required to properly manage their illness.
Less than 5% of Medicare members and 6.8% of beneficiaries with private insurance have used DSMES services, despite treatment advancements and the evidence supporting its effectiveness.
This is certainly a factor in the failure to meet national clinical targets for diabetes. Incorporating the self-care behaviors of healthy coping (for example, having a positive attitude toward diabetes self-management), nourishing eating, being active, taking medication, monitoring, reducing risk, and problem-solving, the Association of Diabetes Care and Education Specialists (ADCES7) Self-Care Behaviors provides an evidence-based framework for an ideal DSMES curriculum.
Referral for DSMES should be implemented and modified at the following four key points: (1) at diagnosis, (2) annually or when targets are not being met, (3) when difficulties emerge, and (4) with transitions in care and life.
Programs overseen by knowledgeable Certified Diabetes Care and Education Specialists (CDCES) and approved by the American Diabetes Association (ADA) should receive DSMES referrals. The multidisciplinary nature of CDCES and their level of clinical expertise make them an extremely important part of the diabetes care team.
In addition to their competence in diabetes education, CDCES has shown that they are capable of managing population health, integrating technology, reducing therapeutic inertia, pursuing quality improvement initiatives, and providing efficient healthcare.
3. Establish a strong foundation in lifestyle medicine.
Healthy food, physical activity, restorative sleep, stress management, abstinence from dangerous behaviors, and strong social ties are all part of lifestyle medicine.
Additionally, there is a strong link between it and the prevention and treatment of chronic diseases like T2D. Living a healthier lifestyle has been linked to a lower risk of getting diabetes, reversing the condition, improving clinical markers like lipids and A1c, losing weight, using fewer drugs, and improving quality of life.
The multidisciplinary care team and CDCES can assist in empowering people with T2D to acquire the information and life skills necessary to develop positive self-care habits and successfully accomplish health goals. When medication management is necessary, lifestyle medicine acts as a supplement rather than a replacement for pharmacologic therapies.
4. Harness technology in diabetes treatment and care delivery.
Technology for managing diabetes is developing quickly and includes glucose monitors, drug delivery systems, data-sharing platforms, and disease self-management software.
Diabetes technology has been found to improve quality of life and clinical results of the condition when used in conjunction with education and support. Despite its advantages, technology can occasionally feel overwhelming to a person with diabetes and their support system.
Diabetes Care and Education Specialists (DCES) can assist the care team and persons with diabetes in locating, implementing, and assessing patient-centered diabetes technology as well as in putting mechanisms in place to increase clinical efficacy and sustainability.
Patient-generated health data reports can offer the care team an efficient and effective assessment of diabetes management and necessary treatment modifications.
5. Assess and address diabetes-related distress.
Diabetes-related distress (DRD) must be evaluated and treated because of the chronic nature of diabetes self-care expectations and their impact on lifestyle choices, medication compliance, and glycemic control.
In addition to the regular context of life objectives and stressors, DRD can be expressed as shame, guilt, wrath, fear, and frustration. An annual therapeutic diabetes care plan should include a simple scale-based assessment of diabetic discomfort.
The ADA Standards of Care in Diabetes urge that medical management include a continuous evaluation of patients’ psychological and social circumstances, including an annual check for depression and other psychological issues.
Patients’ capacity to self-manage their diabetes and achieve healthy outcomes can be greatly impacted by depression, which affects roughly twice as many T2D patients as the general population. A1c and other beneficial outcomes, including as quality of life, can significantly improve as a result of the assessment and treatment of psychosocial components of care.
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