Managing Diabetes through Certified Diabetes Educator Support via Telehealth

 Barriers to Diabetic Management

Diabetic patients often face a condition that is difficult to manage and has many components to understand to self-manage correctly. Each patient can react differently to the same foods and medicines without any obvious reason as to why, and for each patient some days may differ from others. These patients are taught about their blood sugar, checking their readings once very few days to several times per day (How do I use this machine? How do I get a good blood sample?), how to administer their medicines (Is it injectable or oral? How often do I take it? Is there a sliding scale?), having follow up blood work (Every 3 months? How do I get time off work or get transportation?), and don’t forget about the lifestyle changes that need to be part of their everyday to help avoid furthering their condition. These patients often are encouraged to join Diabetic Education classes but there are costs often associated with these classes and hurdles to navigate to get time off work, secure childcare, or find transportation.

Polonsky et al. (2020) demonstrated in their study that Diabetic patients who had access to telehealth support decreased their perceived distress in managing their Diabetes diagnosis. The participants in this study were asked about their overall stress related to the Diabetes diagnosis, managing their treatment and communicating with their clinical team, how the diagnosis will affect their life and family routines, and the effect on their mental health (Polonsky et al., 2020). This study exhibits the complex nature of patients managing this diagnosis and how they are impacted not just physically but mentally, as well. When working with newly diagnosed diabetic patients, it is easy to hear their frustration and fear when talking about all the moving parts that they now have to consider if they want to feel better and not have the complications they’ve heard about or watched their loves one battle.

Guidance for Diabetic Best Practices

Centers for Disease Control and Prevention (CDC, 2022b) explain that the most effective way to truly manage a Diabetes diagnosis is through staying aware of daily blood sugar readings and what foods and activities negatively or positively influence the trend. American Diabetes Association (ADA, 2022b) states that the Hemoglobin A1c test (HgbA1c) is an important part of a Diabetic treatment and self-management plan in that it reflects how well the blood sugar is being managed over a period of time. The ADA (2022b) explains that most Diabetic patients’ HgbA1c target should be 7% or less, and to remember that the higher the Hgb A1c number, the higher the daily blood sugar trend. ADA (2022a), also, emphasizes the importance of healthy eating and healthy activity, making sure to remember that what works for one person may not be the best for another. Implementing these practices and getting to know how daily choices affect a patient’s personal blood sugar trend can go far in helping them feel better and get healthier (ADA, 2022a).

The CDC (2021a) explains that diabetes also affects a patient’s heart, potentially causing twice the risk for heart disease or stroke. Continuous high blood sugar levels injure heart blood vessels and nerves, leading to difficulty for the heart to pump blood to the body (CDC, 2021a). CDC (2021a) explains that, fortunately, many of the same lifestyle changes that can positively influence blood sugar also can improve heart health, such as eating a healthy diet, getting active, managing stress levels, and knowing your numbers (cholesterol, blood pressure, blood sugar, A1c), as well as having a certified diabetes educator (CDE) to help successfully navigate these health conditions.

             

Implementing Telehealth Support

Certified Diabetes Care and Education Specialists provide guidance on daily food choices, exercise habits, and blood sugar monitoring, and can help someone living with Diabetes learn how to manage their condition in a way that improves their health and avoid debilitating complications. According to the Association of Diabetes Care & Education Specialists (ADCES, 2021a), this care team member will help patients self-manage through techniques that fit the patient’s needs and overcome barriers that can threaten improved blood sugar control. The main components to managing diabetes include coping, eating, activity, medicines, blood sugar and A1c monitoring, solving problems for a healthier lifestyle, and risk reduction (ADCES, 2021b). As indicated by Polonsky et al.’s (2020) study, diabetic patients feel more secure and less stress when they have access to clinical support, and using the telehealth mode of providing that support allows the patient to gain this access more easily.

The Florida Department of Health county offices are an ideal partner to gain trust from the providers managing their Diabetic patients, as well as the trust of the public. Establishing CDE representatives at the county office level will allow them to perform grassroots outreach to local providers and their Diabetic patients to enroll them in the telehealth program. These patients will have weekday access to their CDE clinicians, who will work with that patient through scheduled telephonic appointments and provide unscheduled outreach support if messages come through the Department of Health patient portal.

Upon enrollment, each patient will be educated on understanding the role of the CDE representative, understand how to contact their provider for symptom changes, and understand when to seek emergency medical attention; the patients will be reminded of these details throughout program participation. The CDE clinicians will help the participants learn how to make food changes and healthier food choices, learn about blood sugar management techniques, and how activity can improve their blood sugar trend. The CDE representative will be able to guide patients on what to expect from their treatment and how to overcome medication adverse effects. The CDE clinicians will, also, be able to instruct patients on how to use glucometers, insulin syringes, and injectable pens.

By using the telehealth support, these Diabetic patients are anticipated to learn more about their specific condition, and how their diagnosis is best managed through tailored guidance. The goal will be that the participants will demonstrate self-management skills, treatment knowledge, and sick-day action plans within 120 days of entering the program and at that time will graduate from the CDE telehealth support.

                 

Summary

Diabetic patients are often overwhelmed in managing their condition and find it hard to navigate all the new information and expectations to treat this diagnosis. If lifestyle changes aren’t made to improve their blood sugar, this can lead to many health complications including heart disease. Having individualized support by a certified clinician can improve their understanding of treatment, lifestyle changes, and decrease their stress levels. By implementing a telehealth CDE program, more patients can be reached in a manner that allows for ease and convenience, and eliminates the barriers often associated with attending classes or going to the provider office.

 

References

American Diabetes Association. (2022a). Newly diagnosed.            https://www.diabetes.org/diabetes/newly-diagnosed

American Diabetes Association. (2022b). Understanding A1c. https://www.diabetes.org/a1c

Association of Diabetes Care & Education Specialists. (2021a). How a diabetes care and education specialist can help you. https://www.diabeteseducator.org/living-with-diabetes/how-a-diabetes-educator-can-help-you

Association of Diabetes Care & Education Specialists. (2021b). Tools and resources.             https://www.diabeteseducator.org/living-with-diabetes/Tools-and-Resources

Centers for Disease Control and Prevention. (2021a). Diabetes and your heart.             https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html

Centers for Disease Control and Prevention. (2021b). Monitoring your blood sugar.             https://www.cdc.gov/diabetes/managing/managing-blood-sugar/bloodglucosemonitoring.html

Polonsky, W. H., Layne, J. E., Parkin, C. G., Kusiak, C. M., Barleen, N. A., Miller, D. P., Zisser,             H., & Dixon, R. F. (2020). Impact of participation in a virtual diabetes clinic on diabetes-related distress in individuals with Type 2 Diabetes. Clinical Diabetes, 38(4), 357–362. https://doi-org.ju.idm.oclc.org/10.2337/cd19-0105