Contributor: Frank Lavernia, MD
As a young man I always strove to be as independent as possible. But as I matured, I realized that I was more dependent on others to guide me in my endeavors. I guess that is part of growing up; when we’re younger, we think we can find our own path without anybody’s help. Back then, I thought a problem was as simple as reading about it and making a decision – but there is much more to it.
Diabetes is a progressive chronic disorder that left unchecked can lead to vascular complications and asymptomatic problems with kidneys, eyes, heart, and extremities. Clinical inertia (lack of treatment intensification in patients who have not yet met evidence-based goals for their care) can be a leading cause of adverse events including disability, death, and excess medical care costs – very negative patient outcomes, but ones that are potentially preventable with treatment. Specific interventions can help reduce these types of outcomes.
In my medical practice I quickly recognized the importance of creating a diabetes “punch list” with each individual patient. I attempted to deal with most of those issues along with the patient. Over time I saw that I could not do it all, and asked different colleagues for help. This created a wheel of diabetes management and interdependence among all of us, with the patient at the center and we (medical consultants) as spokes radiating out from the patient’s central position.
Looking at our interdependence as another analogy, all of the numerous players around the patient’s table were mutually reliant. Players included clinically trained specialists and providers as well as spouses, family members, and close friends. Identifying all of these interconnected players was critical to avoiding clinical inertia.
As a physician, I continually recognized that diabetes progressively morphs due to changes in the hormonal axis. The β-cells’ insulin output in Type 2 diabetes (T2DM) progressively deteriorates, requiring changes/additions on its therapeutic management. Ultimately, most T2DM patients will require insulin in their diabetes treatment. I learned over time to discuss future insulin use in my initial encounters with patients, so that there was never a sense of failure if they needed to add insulin. Instead I shared a visual graphic of what was happening to their β-cells over time, so they could understand the natural progression of type 2 and why they would likely need to start insulin at some point in the future.
This team educative approach helped energize patient understanding that they could take actions and we could work together to help them avoid many complications. Once they understood that 3-month clinical office reevaluations would help delineate changes in their medical condition, they did not miss appointments. Who doesn’t want to hear their physician say that their actions with food, exercise, medications, checking blood glucose, and other medical office visits make a positive difference? Who doesn’t want to feel like their health care providers are on their side and on their team to stay healthy?
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.