Helping Medical Students Counsel Patients With Uncontrolled Type

Helping Medical Students Counsel Patients With Uncontrolled Type II Diabetes: An Innovative Approach Alice Fairman Daniels, MD, MS Assistant Professor Cook County-Loyola-Provident Family Medicine Residency Program

What is Diabetes • A syndrome of hyperglycemia with many etiologies • A chronic illness that requires continuing medical care and ongoing patient selfmanagement education and support to prevent acute complications and to reduce the risk of long-term complications (ADA)

What is Hb. A 1 c? • Glycated Hb/glycohemoglobin/ glycosylated Hb • Reflects the level of glucose control over the preceding 120 days or 3 months • Normal Hb. A 1 c range: 4. 0%-5. 6% • Pre-Diabetes: 5. 7%-6. 4% • Diabetes: greater than or equal to 6. 5% • Hb. A 1 c: < 7 % is Target range for Diabetics

ABCDEF of Diabetes • Tools to manage Diabetes

ABCDEF of Diabetes • A: Hemoglobin A 1 C <7% q 3 mo • Estimates avg BG over past 3 months & helps determine how well blood sugar has been in control • Glucose(Blood Sugar) - Before Meal: Target =70 -130 - 1 -2 hrs after beginning of meal=<180

ABCDEF OF DIABETES • B: Blood Pressure: Target is 130/80 or less • Check at every visit • BP: The pressure of the blood against artery walls. • High BP can damage arteries and organs. • Pt to ask for BP results

ABCDEF OF DIABETES • C– Cholesterol: Total target is (<200) • • LDL: < 100 Less than 70 if existing heart disease Lipid Panel: yearly HDL: – Male > 40 – Female > 50 • Triglycerides: Less than 150

ABCDEF OF DIABETES • • Damage to kidneys: Albuminuria: Checks for Kidney Damage Target Value: <30 Done Yearly

ABCDEF of Diabetes • Eye Exam: To check if Diabetes caused any damage to your eyes. • Yearly.

ABCDEF of Diabetes • Foot Exam: Remove socks & shoes • Visual Exam: Every visit • Comprehensive Exam • Patient Exam of Feet

Depression As A Hidden Comorbidity In Type II Diabetes Mellitus • Patients with Diabetes have increased risk of developing Depression • Patients with Depression have a greater chance of developing Type II Diabetes • Use Depression Screening Test as a tool to screen for this disease in Type II Diabetics (Center for Epidemiologic Studies Depression Scale-10)

Diabetes and Depression Can Be Treated Together • Difficulty in managing Diabetes can be a stressor and eventually leads to depressive symptoms and Depression • Potential stressors • Effectively managing Diabetes can have a positive outcome on Depression and vice versa

Depression and Diabetes • Depression can lead to: – Weight gain – Sedentary lifestyle – Decreased exercise – Poor Lifestyle Decisions

HEALTH LITERARCY

Long Term Outcomes : Patient Centered • Use PCMH Model • Educate students to: Check Feet @ each visit Teach correct method to check blood sugars and record on blood sugar Record and review at each encounter. Prevent/Decrease incidents of: Diabetic Retinopathy, Ketoacidosis, Nephropathy, Polyneuropathy and Necrobiosis Lipoidica

Methods To Increase Student Awareness of Type II Diabetic Complications • 1. Give Handout for student on Standards of Care in Diabetes -2011 by ADA. 2. Lecture on Diabetes • 3. Student to Participate In Diabetic Group Visit Teaching and PCMH Diabetic Teaching • 4. Compile Roster of Type II Diabetic patients in my office with known Diabetic Complications attributed to this disease for student to examine during patient’s office visit • 5. Student to spend 2 days in Podiatry Clinic observing and examining patients with Diabetic Foot Problems.