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Diabetes Discoveries & Practice Blog

Diabetes Prevention and Management in the Primary Care Setting

Diabetes prevention and timely intervention are important in the primary care setting.

Primary care physicians face many challenges when it comes to diabetes care, but with access to programs and resources within the community, they do not need to face these challenges alone. In the second video from the “Diabetes Care: Finding Common Ground with Guiding Principles” blog series, Dr. Jay H. Shubrook shares tips for how health care professionals can better help patients with or at risk for diabetes and make patient visits more efficient in the primary care setting.

Download the Guiding Principles for the Care of People with or at Risk for Diabetes, updated in August 2018, to learn more about existing guidelines that have been synthesized to help primary care providers and health care teams deliver quality care to adults with or at risk for diabetes.

In primary care, there’s a lot of challenges to do good diabetes care and I think part of it is that the system is set up in such a way that we really focus on volume of care. We're seeing a lot of patients, it's focused around the chief complaint, and we know that diabetes as a prototypical chronic disease requires lots of attention to detail and a long-term plan, not just a short-term plan.

I feel that diabetes warrants at least four visits per year in the primary care setting. So, that's one hour; we have more than 8,000 hours in a year. Diabetes deserves at least one hour. So, I want to be respectful of my patient who does have a complaint, so if they come in with a headache or sore throat that day, I might say, “Let's take time, let's figure out what this is. But we're going to reschedule this diabetes appointment for next week so that we give diabetes the attention it needs as well,” because otherwise I'm shortchanging both the sore throat and the diabetes management, and that's not good for anybody.

So, diabetes prevention is of course critically important for primary care and for public health. I think that probably our best dollar spent is on prevention. I feel like in primary care, there's still very little knowledge about the Diabetes Prevention Program, there's very little knowledge about the importance of timely intervention, and then there's also a lack of awareness of where to get those resources.

What I love about the Guiding Principles from the National Diabetes Education Program is it’s largely endorsed by many organizations.

It's got very simple actionable items that we can work on, and I think quite honestly, it's one of the many resources that I think primary care should utilize to provide the best care possible for their patients with diabetes.

I can say confidently that primary care has one of the toughest jobs in the world, they manage so many things. But at the same time, they don't have to do it alone. Knowing where these programs are available in their community, using them as a resource to help our patients, really is something that I think is our next level. We need to have awareness about diabetes and prediabetes, but then also the resources available in the community to help our patients.

So, if I had to leave anything for primary care providers about their interface with patients with diabetes, there's probably three things:

One is that diabetes needs four visits per year – at a minimum – to give it the proper attention. Two is, there are many things that you could do to make your diabetes visits more efficient. One of the things I would say is have a download station. If we try to look at manual glucose logs, that'll take longer than I have for the entire appointment. So, get a download station so you can download your devices. And then three, recognize your patients for the process that they do, not the outcome.

So, if a patient comes in and they're checking their sugars three times a day and they're taking their medication, they get a high five because they're doing a lot of hard work no matter what their number is. And so, I think if we're engaging patients in the long haul, we need to give them the recognition that the work is really what should be recognized and the outcomes are the bonus.

Dr. Jay H. Shubrook

About the Expert

Jay H. Shubrook, DO, is a board-certified family physician and diabetologist. He is a professor in the primary care department at the Touro University California College of Osteopathic Medicine, where he also serves as the director of clinical research and director of diabetes services. He is the chair of the Primary Care Advisory Group for the American Diabetes Association. He strives to better prepare primary care providers to provide exceptional care for patients with diabetes, and his research interests focus on type 2 diabetes prevention and early intervention.

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