Three ways to increase compliance among diabetic patients

Getting early control of diabetes should be an important goal for both healthcare providers and patients. Large clinical trials-The Diabetes Control and Complications Trial (type 1 diabetes) and the UK Prospective Diabetes Study (type 2 diabetes)-have found that getting the disease under control early on has immediate benefits.

But, more importantly, researchers have found that among patients who proactively addressed diabetes problems early on, five to 12 years later the benefits of that early attention persisted or became even better, despite the fact that glucose control was no longer as good.

“Early investment equates to long-term benefits,” says Jay H. Shubrook, DO, director of Diabetes Services and Clinical Research, and professor and diabetologist, Touro University California College of Osteopathic Medicine, located in Vallejo, California.

Diabetes is associated with an increased risk of complications including kidney disease, eye disease, cardiovascular disease, and premature death. “Diabetic patients can avoid many of these complications by adhering to treatment guidelines,” says Stephenie Lucas, MD, endocrinologist, Beaumont Hospital, Grosse Pointe, Michigan. “This is especially important now because many new medications and treatment modalities make it easier to achieve and maintain diabetic guidelines.”

1. Provide patients with a variety of care options

Unlike other diseases, it is estimated that 90% to 95% of diabetes care requires self-care. In an effort to get patients to comply with treatment plans, Shubrook’s institution makes great efforts to provide patients with a variety of methods to obtain care.

For example, they offer one-on-one appointments, group appointments, and different classes with peers. “We find that some patients prefer to hear from their contemporaries,” he says. “We have also found that our team approach-which includes osteopathic physicians, physician assistants, and pharmacists-provides patients with different types of information and as a team we learn much more.

Finally, we have invested time and effort to better understand our patients’ health literacy numeracy and food security (i.e., their ability to afford and have access to fresh food) so we can tailor our message as specifically as possible to each patient.”

Next: Use a multidisciplinary team of providers

2. Use a multidisciplinary team of providers

Beaumont Hospital has also found that a multidisciplinary team approach provides more effective care. Its multidisciplinary diabetes management team includes an endocrinologist, podiatrist, ophthalmologist, registered nurses, and registered dieticians-who are all certified diabetes educators.

The team is certified by the Michigan Department of Public Health and recognized by the American Diabetes Association. All of the non-physician educators in the Diabetes Management Program at Beaumont are nationally certified as diabetes educators. “Patients have the added assurance that they are receiving the best guidance and treatment modalities available,” Lucas says.

Beaumont also has support groups for patients with diabetes. “Having support from other patients can make it easier for them to manage their diabetes,” Lucas says.

3. Tailor your treatment plans

Gregory Deines, DO, division chief, Diabetes/Endocrinology, Spectrum Health, Grand Rapids, Michigan, says the facility’s multi-disciplinary care team places the patient and his or her goals at the center of treatment plans.

Team members include a physician or physician assistant, registered nurse/CDE care managers, registered dietician/CDE, social workers, and a psychotherapist. The latter two help to screen for behavioral health concerns and provide counseling and treatment for behavioral health issues that can be barriers to effective diabetes self-management.

“The team evaluates patients at every visit and identifies barriers to their optimal care,” he says. “Strategies for overcoming the barriers and implementing optimal care are developed in cooperation with the patient, their family, and primary care team.”

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.