Members of the Diabetes Care Team, Explored
Experts highlight the roles of various health care professionals who play a role in the management of patients with type 2 diabetes.
Troy Trygstad, PharmD, MBA, PhD: When you think about diabetes care, as we discussed earlier, there are a lot of comorbidities. Lifestyle management, diet, exercise, and multiple therapies are involved. This is a chronic disease. It seems that it takes a village to take care for a person with type 2 diabetes. Who are some of the other actors in this play? Who are some of the other care-team members who might play a really important role in taking care of a diabetic patient?
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: I could go first. I’m sitting in the endocrine service, and our follow-up is around 3 to 4 months after we see them. The endocrinologists rely on a huge slew of folks on the back end, making sure that within those 3 to 4 months a lot of stuff happens. There is a referral to our pharmacists. There is a referral to nutrition. Maybe they go get their eyes checked or go to a podiatrist. We are making sure all immunizations happen through nursing and not through pharmacy. And so making sure that they go and get their appropriate immunizations is important. There are a lot of players when we think about general maintenance and routine things that are involved with diabetes care. There are a lot of folks who need to kind of connect that dot.
Troy Trygstad, PharmD, MBA, PhD: So we have physicians.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: Yes.
Troy Trygstad, PharmD, MBA, PhD: Pharmacists. Who are the other actors, or what are the other types of disciplines?
Susan Cornell, PharmD, CDE, FAPhA, FAADE: Dietitians, nurses, and podiatrists.
Jessica L. Kerr, PharmD: I’ve had great response and help from the clinical psychologist who we have in our clinic. We’re blessed to have that service in the primary care clinic. It’s overwhelming for these patients, whether it’s for new diagnosis or just as the disease stage progressed, because it’s life going on. And so, finding out what some of their barriers are to certain therapies, or just trying to figure out…
“We talked about this and he/she understands it. What is the reason that we’re not moving forward?” Those clinical psychologists really can help to get in there to identify that, and then they can work with cognitive behavioral aspects to make sure that we can try to work together as a team.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: Social workers, health coaches.
Susan Cornell, PharmD, CDE, FAPhA, FAADE: Yeah. I was going to say that the biggest health care professional actually seeing or identifying diabetes first right now is the dentist. People are more routinely going to see their dentist than their doctor. Actually, many dental offices are now actually doing diabetes screenings and are catching people with diabetes to refer. The other thing too is audiology. Right now there’s a big push within the audiology project because, if we think about it, hearing loss has to do with the microvascular disease.
People often experience a hearing loss and don’t even know they have diabetes. So we are looking at all of this, but then we also have to look at the patient and what they are doing. This is a lot of stress. Jess, you mentioned how overwhelming this can be. What is the patient doing in terms of coping? There have actually been studies that looked at yoga and tai chi in reducing A1C [glycated hemoglobin] level, and breathing and relaxation. So again, the coping mechanisms.
So I think we have to look at it as more than just the health care providers. Our partners. Our community partners. Are they working with a massage therapist? Or again, a yoga instructor? We see a lot of people who struggle. We go into food pantries to actually try to help people who are struggling through this and allow them to receive the educational services that they need. I think that’s where we come in. We’re CDEs, or certified diabetes educators. We know the process of how to educate the patient. If we think about it, how many times will prescribers tell a patient, “Do this”? But what percentage of patients really follow through?
Troy Trygstad, PharmD, MBA, PhD: Or understand what this is.
Susan Cornell, PharmD, CDE, FAPhA, FAADE: Exactly. So I think that’s why, again, teaching the patient to solve their own problems and manage their condition is important. As a CDE, that is our job: To work with these patients and help them better control their condition.