Providing care to the 12 million seniors over age 65 living with diabetes poses a unique set of challenges. And according to the Centers for Disease Control and Prevention’s 2017 National Diabetes Statistics Report, diabetes kills more Americans every year than AIDS and breast cancer combined, so the stakes are high.
To help health care providers get the necessary tools and resources, the Centers for Medicare & Medicaid Services Quality Improvement Organization (QIO) Program held a National Learning & Action Network Series event in February 2019 titled, “Patient-Centered Treatment Options for Type 2 Diabetes.”
One patient’s story opened the event with context and insight: Health care consultant and patient advocate Patrick Gee shared his experience with type 2 diabetes, explaining how lifestyle changes and self-care education, combined with person-centered management plans, lifted his long-term prospects.
Despite a family history of diabetes, Gee said he never grasped the seriousness of the disease. A lack of education contributed to lifestyle choices that ultimately led to severe health complications, including kidney failure, sarcoidosis and susceptibility to bone and lung cancer.
It wasn’t until his doctors worked with him on a person-centered plan that he was able to make real changes to improve his health, including going to a weight loss clinic and starting an acidogenic diet.
For Gee, the biggest takeaway from his experience is that he now understands how to manage his disease. He eats healthful food and exercises three times per week, which has allowed him to stop taking insulin. Now planning to run a 10K race in the spring, he’s living a healthier lifestyle, can control his diabetes and is no longer obese.
Replicating Patrick Gee’s success
Also speaking at the event, John Buse, professor at the University of North Carolina (UNC) School of Medicine and director of the UNC Diabetes Care Center, highlighted his recent research on diabetes. He shared three tips to maximize care quality and improve health outcomes for patients with type 2 diabetes:
1. Place a greater emphasis on the person
Buse pointed out that a greater focus on patient-related issues and self-management had a significant impact on the success of interventions for patients with type 2 diabetes in his study. Specifically, Buse highlighted success using weight loss and obesity management, including metabolic surgery.
Success with self-management stems from the need for patients to truly believe drastic lifestyle changes will lead to successful outcomes, Buse noted. He recommended a patient-centered decision cycle that sets realistic goals to prevent complications and optimize quality of life.
2. Assess all relevant characteristics when determining a care plan
Lifestyle, existing health conditions, clinical characteristics, issues such as motivation or depression, and cultural and socio-economic context play an important role in determining a treatment plan, Buse explained.
He shared that comorbidities such as established atherosclerotic cardiovascular disease, chronic kidney disease and heart failure should play a role in determining which glucose-lowering medication is prescribed, which is a new development since 2015.
3. Review a patient’s management plan with them at least once per year
Bottom line: Patients are unlikely to follow an intervention plan if they are simply told what to do. By working collaboratively to determine how to manage their disease, patients are more likely to feel empowered, set realistic, achievable goals and make a significant lifestyle change. Buse recommended reviewing the plan at least once per year with the patient to assess what’s working–and what isn’t.
Slides from the webinar can be found here.