Diabetes Education: Meeting the Challenge for Your Patients
August 2007 Issue
Diabetes is a disease that can be controlled-or greatly exacerbated-by a patient's overall lifestyle. It's a disease that calls strongly for healthcare professionals to look at the "whole person," not just the aspect of the patient's health they are treating.
How important is it to see that your patients -no matter what your role is in their treatment-get the information and the follow-up they need? It can literally be a matter of life and death. Diabetes can lead to heart disease and stroke, kidney disease, diabetic neuropathy, skin and foot complications, vascular problems, eye complications, and even blindness. Diabetes is a leading cause of lower-limb amputations. Once you've lost one limb, the risk to the other is extremely high, points out Amparo Gonzalez, RN, BSN, CDE, president-elect of the American Association of Diabetes Educators (AADE) and director of the Georgia Latino Diabetes Program affiliated with the Emory University School of Medicine, Atlanta.
Can You Play a Role?
Any professional treating patients with diabetes should be prepared to provide basic education in diabetes self-management regarding diet, exercise, foot care, controlling glucose levels, and other concerns, according to Gonzalez. "Many people with diabetes aren't connected with a diabetes educator; they are getting their diabetes education in other ways. So it really helps the patient when others on the healthcare team are able to provide basic knowledge... When the patient has a question, such as, 'Can I eat pineapple?' etc., he needs to have these questions answered."
Patients with diabetes may be in denial-not accepting the reality of their disease; others may be dealing with depression, points out Rebecca Sanchez, RN, MPH, director of education at the Texas Diabetes Institute (TDI), San Antonio. "We need to convince them to check themselves. We teach them why it's important to better manage sugar levels in order to establish a baseline and work toward a level balance in sugar control rather than peaks and lows. We teach them how to use the glucose meter, how to eat more healthfully, and about portion control."
Healthcare professionals can help by opening the diabetes discussion: "How is your diet going? How are you doing with your sugar?" They can be prepared to help educate and motivate their patients, Gonzalez points out.
Providing Patient Information
As an orthotist, pedorthist, or prosthetist, how can you assume, at least in part, the role of a diabetes educator? Many diabetes care centers, hospitals, and diabetes organizations offer courses and seminars for healthcare professionals to increase your knowledge. Various organizations provide brochures and pamphlets in English and Spanish either free or at a moderate charge that you can give to your patients. Having information available in Spanish can be very helpful, since statistics show that 25 percent of Latinos between the ages of 45 and 74 living in the United States have diabetes-a much higher rate than the general population. Much helpful information is also available online for patients in both languages, as well as information specifically for healthcare professionals.
Another tool for pedorthists and O&P practitioners is monofilament testing, an easy, inexpensive, and effective way to screen for foot neuropathy. Foot neuropathy puts patients at risk for ulcers that can lead to amputation. The foundation of this prevention program is a 5.07 monofilament calibrated to apply ten grams of force when pressed against the foot. You can obtain the monofilaments with use instructions from the Lower Extremity Amputee Prevention (LEAP) program, administered through the U.S. Department of Health & Human Services Health Resources Services Administration (HRSA). You also can teach your patients how to perform this test at home. For more information, visit www.hrsa.gov/leap
How Diabetes Educators Can Help
Should you bring a diabetes educator into the picture? How can a diabetes educator help your patients with diabetes?
Seven Tenets of Diabetes Education
According to the AADE website, diabetes education focuses on seven essential self-care behaviors, called The AADE7™ Self-Care Behaviors:
"Diabetes education, also called diabetes self-management training (DSMT), is a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions. The intervention aims to achieve optimal health status, better quality of life, and reduce the need for costly healthcare."
For more information, visit www.diabeteseducator.org
Diabetes educators are health professionals from a variety of disciplines, including nurses, dietitians, pharmacists, doctors, exercise physiologists, podiatrists, and social workers, among others. They specialize in providing care and education to people with diabetes. Many are also certified diabetes educators (CDE), which means they have met additional care criteria.
These professionals counsel patients on how to incorporate healthy eating and physical activity into their lives. They also help patients understand how their medications work, teach them how to monitor their blood glucose to avoid the risk of complications, and provide guidance on problem solving and adjusting emotionally to diabetes. By getting to know patients as individuals, they are able to help create a self-management plan that meets their needs-one based on age, school or work schedule, as well as daily activities, family demands, eating habits, and health problems. For example, TDI offers a ten-hour program of classes for patients with diabetes on all aspects of understanding and managing their disease. For those who are unable to take the classes, TDI provides a one-hour session of one-on-one instruction from a nurse. TDI focuses on the team approach to treatment, bringing together family physicians, endocrinologists, renal specialists, orthopedists, ophthalmologists, dermatologists, podiatrists, physical and occupational therapists, diabetes educators, and orthotists and prosthetists.
Diabetes educators, orthotists/prosthetists, and pedorthists can benefit from one another and the patient, Gonzalez points out. Diabetes educators who have built a relationship with an O&P practitioner or pedorthist whom they trust can direct referrals to them; likewise, orthotists/prosthetists and pedorthists can refer their patients to the diabetes educator. Diabetes educators in your area can be located through a directory on the AADE website, www.diabeteseducator.org
Gonzalez, for example, helped set up an arrangement at a shoe store in the hospital area that had two pedorthists on staff. Her program presented a diabetes education session in the store twice a month and kept educational materials available at the store. In turn, the pedorthists came to the center and taught a class in foot care. At health fairs, the pedorthists provided gait evaluations.
Helping Patients Take Control
Patients with diabetes need to take charge of their disease, rather than letting it take control of them. They do this by being motivated to make lifestyle changes in exercise and nutrition, and through careful monitoring of their blood glucose levels, along with regular follow-up by healthcare professionals. Controlling diabetes is not a one-time challenge-it's a lifetime challenge.
You, the orthotist, prosthetist, or pedorthist, no matter the size or affiliation of your practice, can also play a part in helping your patients to get on-and stay on-the road to successful self-management of diabetes.
Miki Fairley is contributing editor for The O&P EDGE and a freelance writer based in southwest Colorado. She can be contacted via e-mail at email@example.com