Contributor: Frank Lavernia, MD
In my 35 years as a clinical diabetes practitioner, I have had a few epiphanies along the way. Realizing that I did not understand car talk, some sports jargon, or dense legalese made me much more sensitive to what my patients needed to understand to make informed decisions about their diabetes. Identifying health literacy early in our encounters helped tremendously. Better yet, I welcomed loved ones with the patient’s consent into the exam room during these important conversations. Over time, our patient/doctor relationships seemed to blossom easier.
The patriarchal doctor’s approach is long dead. Some clinicians call it informed decision making, but I always thought of it as the buy-in. Without it, I found it a disastrous journey. If the patient was not ready and/or prepared to make changes needed to tighten their diabetes management, it just was not going to happen! It was my duty to convince them that we, as a team, could make one change at a time, and that they could see positive impacts on their lives with this chronic disorder.
I quickly learned what Dr. Elliot P. Joslin meant by “the person with diabetes who knows the most lives the longest.” It became my mantra when I started my diabetes center in Pompano Beach, Florida. Our center, approved by the American Diabetes Association, was run by our nurse educator (CDE) and her staff which included a registered dietitian, exercise physiologist, psychologist, ophthalmologist, and podiatrist. This team offered patient education and overall assistance answering all of their queries in a model based on a wheel, surrounding the patient (center) with each of their specialties important to diabetes care (spokes).
Over time the ADA, insurance companies, and government have realized the positive impact that diabetes education has on patient outcomes. All patients with newly discovered diabetes should be exposed to such a program that has a dedicated team with empowerment as the end product. “Going back to school” is also critical for our patients that are already into years of diabetes. Diabetes is a moving target with all of the newer findings and treatment modalities. I would always remind my patients that it was important to work with their doctor(s) to keep up with all of the new findings. He had to reboot to keep up, too.
With time, I also learned to better understand diabetes distress and how to help patients deal with it. There is a high prevalence of diabetes distress that is associated with low diabetes self-efficacy and lower levels of glycemic control, self-care, and quality of life, even after controlling for clinical depression. As a provider and a person without diabetes, I would imagine myself in a hypothetical situation of living with diabetes and getting an A1c result that was higher than my goal - despite taking all of my meds and following my treatment plan. Knowing everything that I would do (meals, exercise, taking meds, checking BG) had an impact on my chronic disorder, I had another epiphany: diabetes is a tough disease to deal with.
Dr. Lavernia has been a practicing diabetologist in South Florida for more than 35 years. He was the founder and director of the North Broward Diabetes Center in Florida. He is an adjunct faculty member of the National Diabetes Education Initiative (NDEI), Vascular Biology Working Group (VBWG), and for the Coalition for the Advancement of Cardiovascular Health (COACH). He is also a member of the American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes, and the National Hispanic Medical Association. He is a new member of the DiabetesSisters Board of Directors.