Patients need education about underlying causes
Patients need education about underlying causes
Lack of information equals poor control
A survey showing 62% of patients with Type 2 diabetes are unable to identify insulin resistance as the underlying cause of their disease, astonishing leaders of the American Association of Diabetes Educators (AADE), who commissioned the survey.
Not surprisingly, those who cannot define the cause of their disease have much poorer control, according to AADE president Christine Tobin, RN, MBA, CDE, an Atlanta-based health care consultant.
A telephone poll was conducted by Yankel-ovich Partners of Norwalk, CT. The research firm called 1,000 Type 2 diabetics over the age of 45. The results include:
• 88% reported diet and exercise were part of their diabetes regimen.
• 84% said they were using oral agents to help control their diabetes.
• 72% wanted more information about their disease.
• 75% did not seek support in coping with their diabetes.
• 92% knew their blood sugar level, and 88% knew their blood sugar level target.
• 75% did not know their HbA1c level, and 77% did not know the target HbA1c for control.
• 97% were being treated by a physician, but only 28% had discussed insulin resistance with a physician or other health care professional.
"These findings are alarming and demonstrate the critical need for greater education about insulin resistance to help patients keep their diabetes in check," says Tobin.
Since most diagnoses were made by primary care providers, and most physicians do not employ a diabetes educator, the education needs to be done outside the doctor-patient office visit, says Tobin. "With less than 10 minutes to examine, diagnose, and prescribe, how much diabetes education do you think occurred?" she asks. "This survey underscores the need for increasing access to educational efforts to let patients know where to go to get help."
Tobin’s advice to diabetes educators: "This survey tells you to make contacts and market yourself and your program. Ask for referrals. Make sure physicians and other health care providers know what you can do for them and their office as well as for their patients."
Diabetes education is expensive and currently is not covered by many insurance plans. Medicare does not cover education, but Tobin says new Health Care Financing Administration (HCFA) regulations — now mired in bureaucratic red tape — eventually may change that and bring most insurers into the diabetes education arena as well.
"That puts a lot of lot of education programs out on a limb and on hold." She adds it likely will be several more months before HCFA sifts through more than 1,000 comments received on regulations drafted in response to the August 1997 legislation that includes coverage for diabetes education.
Until then, diabetes education is out of reach for many patients, says Betsy Bohannon, MD RD, CDE, educator at the diabetes clinic at the University of Tennessee at Knoxville. She says it is "mind boggling" how few patients have an opportunity to get information about the best way to manage a very complex disease.
She notes that the University of Tennessee’s basic half-day program for newly diagnosed diabetics costs $350 and the four-day intensive program "for people in trouble" costs $2,000. "That’s just not in reach for most people unless insurance helps out."
"Diabetes education is a lifelong process, so someone who was diagnosed a few years ago may need a refresher. The amount of information they receive when they are newly diagnosed cannot possibly be completely absorbed," she says.
The state of diabetes self-management is rapidly evolving, says Tobin, which means re-education and constant reinforcement are essential to help patients achieve good control.
She says that researchers have demonstrated the benefits of tight glycemic control for Type 1 and Type 2 diabetics alike. New drugs like the thiazolidinediones or "glitazones" being developed can make a major difference in helping patients achieve glycemic control. But there’s more to diabetes education than hammering home the idea of glycemic control. Diabetes educators need to be talking with their patients about more than just diabetes.
"Don’t forget to talk to them about the comorbid diseases such as hyperlipidemia, hypertension, and heart disease," she says. "And when those complications arise, it is crucial that they get the information they need at that time."
So many patients don’t get the concepts behind their diabetes because there is frequently little physical manifestation of the disease in the newly diagnosed, says Anne Whittington, MBA, MSN, RN, CDE, a diabetes educator at the Medical College of Georgia in Augusta.
Until complications arise, there is little impetus to take preventive measures in the usual health care setting, she explains. "It’s not human nature to do anything about something that doesn’t exist yet."
Obviously, she does not advocate waiting until complications arise to educate patients about the need for good glycemic control. "We need to find methods for the patients to connect the causes and effects of insulin resistance to their daily lives so we can help facilitate changes in behavior."
The ongoing challenge, says Whittington, involves tailored, individualized attention to each patient, finding that patient’s "hot buttons."
Bohannon adds it is important to prepare patients emotionally to hear the message an educator is sending. "A person is usually in shock and overwhelmed at the time of diagnosis. That doesn’t set a good stage for much learning at all, yet that’s when people are referred to an education program if they are going to be referred at all."
Whittington offers a suggestion: "We need to work with the patients to find out where they are coming from and what they are willing to do to accomplish short-term goals. When [the situation] is seen with crystal clarity by the patient, the patient will make the changes."
[For more information, contact Christine Tobin at (404) 636-0213, Betsy Bohannon at (423) 544-9858, and Anne Whittington at (706) 721-6895.]
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