Team Approach to Type 2 Diabetes Management
Comprehensive care of patients with diabetes requires a team of healthcare professionals. Working with different healthcare providers allows the patient to learn in-depth information regarding their health and well-being. It also ensures that the patient’s needs are cared for and addressed. It is important to use other providers’ skills and specialties to ensure patients have the best care and understanding of their condition. Often, problems may be apparent to one healthcare provider, but go unnoticed by another. For example, recognizing a patient’s illiteracy or vision problems in a group class may be difficult, but these problems may be obvious during a one-on-one encounter.1
Certified Diabetes Educators
A certified diabetes educator (CDE) is generally a nurse or registered dietitian, but could be another healthcare professional. CDEs teach in a variety of inpatient and outpatient settings. They cover all topics related to diabetes management from insulin administration to foot care and are often the primary providers of diabetes self-management education (DSME). They often have more time than physicians to devote to each patient, which allows them to focus on specific needs. Often patients report they receive more practical knowledge from their CDE than they do from their physician. Having a CDE credential indicates the passing of the certification examination and special ability in this area.1
Diabetes Self-Management Education (DSME)
DSME is an ongoing program that helps patients acquire the knowledge, skill, and ability necessary for diabetes self-care. The needs, goals, and life experiences of the individual with diabetes are taken into account in the development of each program, which is also guided by evidence-based standards. The overall objectives of DSME are to support the following:2
- Informed decision making
- Self-care behaviors
- Problem solving
- Active collaboration with the healthcare team
- Improvements in clinical outcomes, health status, and quality of life
The American Association of Diabetes Educators has outlined 5 key steps for the implementation of DSME, as follows:3
- Assessment: evaluate the patient’s medical and personal history and characteristics.
- Goal setting: collaborate with the patient to develop goals and priorities.
- Planning: develop strategies and tactical approaches to address needs and overcome barriers.
- Implementation: provide ongoing support and education to the patient to execute the agreed-upon plan to meet agreed-upon goals.
- Evaluation and follow-up: provide ongoing reassessment of goals, strategies, and patient’s condition.
Registered dietitians can provide diet-related diabetes education and can also help patients develop healthful eating plans that are appropriate to individual needs and circumstances. For instance, they can document and help address problems such as disordered meal patterns, timing of meals, eating disorders, lack of money for food, and other physiological and psychosocial problems. These issues may not be identified during physician office visits.1
Registered nurses can provide an assessment before the physician sees the patient, which allows for a better focus on any identified problems. Teaching medication administration is another important area that can be delegated to a nurse. Physician time can be saved when the nurse fields phone calls related to medication administration, assessment of medication tolerability, and other related diabetes management issues.1
Nurse Practitioners and Physician Assistants
These providers can create treatment plans and set goals that other team members will implement in the patient’s care, allowing the physician to focus on specific treatment issues. Also, these providers often take over some treatment decisions, thus freeing the physician to concentrate on other healthcare issues.1
Primary Care and Other Specialist Physicians
Even when a patient’s diabetes care is delivered primarily by an endocrinologist, it is important that the patient also has a primary care physician, because these clinicians address other aspects of care beyond diabetes alone. Typically, specialists have longer wait times for appointments, so patients might not be seen on a timely basis for medical issues that need more immediate evaluation.1
The diabetes healthcare team may also include various other specialists such as (but not limited to):1
- Handelsman Y, Mechanick JI, Blonde L, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011;17 Suppl 2:1-53.
- Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care. 2012;35 Suppl 1:S101-108.
- American Association of Diabetes Educators. AADE guidelines for the practice of diabetes self-management education and training (DSME/T). Chicago, IL: American Association of Diabetes Educators; 2010; Available from: http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/researc....