Diabetes Treatment and Prevention at the Primary Care Level

A recent article in Medical Economics highlights the challenges of effective diabetes treatment. The article cites that almost half of all patients diagnosed with diabetes don’t meet their goals. This includes the A1C, LDL cholesterol and BP.

prevention better than cure

With the shift to value-based medicine with schemes such as MIPS, physicians are now being rewarded or punished financially based on their ability to meet quality metrics. This includes diabetes management.

The Problem

One of the biggest challenges for doctors in managing chronic diseases lies in patient motivation and having them adhere to their treatment plans while managing quality metrics.

Diabetes is a disease that is measured in numbers. To date, this has provided little perceived control for the patient to manage their condition. What does help with motivating patients is having conversations with them. Talking with patients about how they are feeling and what they are doing is key to behavior change. Doctors, however, feel time pressured and do not make the time to do this effectively due to the time required to be updating their EHR systems to remain compliant.

Lifestyle changes are the hardest to make and an area that continually frustrates physicians. Working with patients to create small achievable goals and helping the patient understand the impact of even a small change in weight can make a big difference.

What can be done?

Regular diagnostics, education, and motivational conversations are important for effective treatment says Ashok Balasubramanyam, MD, an endocrinologist and professor of medicine in the Division of Diabetes, Endocrinology and Metabolism at Baylor College of Medicine, Houston.

Randall Stafford, MD, Ph.D. is an internist and Director at the Program on Prevention and Practices at Stanford Preventive Research Center. Stafford helps his patients through motivational conversations to empower patients toward behavior change. These conversations must be done in a safe and meaningful way to the patient. He states, “We drastically undersell behavior as a strategy in diabetes. Behaviors are important links to what people can do to better manage their diabetes.”

Many primary care practices refer diabetic cases out. Stafford says that primary care should be able to care for patients who are on insulin and oral medications without the need to refer out. This benefits the patient by providing whole person health and keeping the patient in the comfort of their primary care provider.

Helping patients lose even just a few pounds can help with diabetes control and reduce the risk of other health problems. Neuropathy is cited as the most common complication of diabetes. Regular diagnostics help identify complications early including assessment of the ANS, hands, feet, fall risk and cardiovascular system.

Proactive physicians are starting to seek more solutions for their at-risk patients. Recent programs such as the National Diabetes Prevention Program have found that as little as a 5-7% loss in weight can reduce diabetes risk by 58%. Physicians are well placed to provide and support their patients to lose weight with the right education, conversations, and tools.

The Diabetic Diagnostics and Treatment Protocol (DDTP) is a full practice solution for proactive physicians looking to be leaders in improving health outcomes through early detection and assessment of diabetes and prediabetes. Proactive physicians typically seek prevention and data that provide the information they need to accurately assess and educate patients on their progress and condition. As patients lose weight, retesting for improvement in data is possible with sensitive and objective tools targeted to diabetic complications.

Motivational counseling has also been a roadblock for physicians as many are unfamiliar with the techniques required to be effective in supporting behavioral change. The DDTP supports patient and provider education by stepping them through modules specific to the habit changes needed. These changes center around 9 core areas and 44 modules that are specific to the challenge’s patients face when it comes to losing weight.

If you or your practice are interested in becoming leaders in diabetes prevention and treatment and want to find out more, complete the form below.