6 Diabetes Recommendations Retail Clinicians Should Know

Retail clinicians should recognize their role in promoting high-quality care for patients with diabetes.

The American Diabetes Association (ADA) recently published its 2016 Standards of Medical Care in Diabetes. These recommendations, which appeared in theAnnals of Internal Medicine, highlighted individualized care strategies to manage diabetes, prevent or delay complications, and improve outcomes.

In light of the shortage of primary care physicians, more and more patients areturning to nurse practitionersfor their regular primary care visits. This trend creates an opportunity for retail clinicians to play an important management role for all patients, especially those with chronic conditions such as diabetes.

The following are 6 key areas for diabetes care.

1. Disease Type Diagnosis

The ADA emphasized that correctly classifying a patient with type 1 or type 2 diabetes as early as possible is crucial because management strategies for the 2 types differ significantly.

Kristene Diggins, FAANP, CNE, NEA-BC, DNP, DCC, MBA,previously toldContemporary Clinicthat one of the dynamic trends in diabetes is closely following the patient as soon as the health care provider knows they have the disease in order to ensure that proper management techniques are adopted early and consistently.

“That is where the convenient care clinician has an opportunity to act and act quickly,” she said. “This patient may not be seeing any other health care provider.”

Beyond general diabetes counseling, retail clinicians can help alert women of childbearing age that if they are obese and diabetic prior to getting pregnant, they are more likely to have ababy with autismor have troublebreastfeeding.

2. Glycemic Targets

“Self-monitoring of blood glucose is integral to effective therapy, allowing patients to evaluate their individual response and assess whether glycemic targets are being achieved,” the ADA wrote.

Hemoglobin A1C levels have a strong predictive value for diabetes complications, and the ADA noted that the frequency of such testing should depend on the clinical situation, treatment regimen, and clinician’s judgment.

Dr. Digginspreviously toldContemporary Clinicthat “aggressive action” with respect to glycemic control is pivotal for clinicians to feel comfortable.

“A sense of not wanting to harm the patient...is the number one reason why clinicians don’t act and treat diabetes and chronic diseases,” she said. “But the fear of action is actually what ends up harming the patient.”

3. Diabetes Interventions

“Optimal diabetes care addresses behavioral, dietary, lifestyle, and pharmaceutical interventions,” the ADA advised. “All patients should participate in diabetes self-management education and support.”

As some of the most accessible health care providers in their communities, retail clinicians can play a critical role in counseling patients with diabetes on these interventions.

Kathleen M. Dailey, MS, FNP-C, a board-certified family nurse practitioner and state practice manager for MinuteClinic,previously toldContemporary Clinicthat nurse practitioners and physician assistants play an important role in community awareness about public health.

“The rapid increase in number of pharmacy clinics is well-known, and their pharmacists, nurse practitioners, and physician assistants are the most accessible health care providers to community members,” Dr. Dailey said. “Among the wellness services offered at these community-based clinics are diabetes screening and monitoring, as well as weight management.”

4. Hypoglycemia Prevention

“Providers should be vigilant in preventing hypoglycemia in patients with advanced disease and should not aggressively attempt to achieve near-normal HbA1C levels in patients in whom such targets cannot safely and reasonably reached,” the ADA stated.

Newly diagnosed patients need education regarding recognition of signs and symptoms of hypoglycemia and other serious complications. Retail clinicians can offer a comprehensive education program to help patients minimize their risks.

Retail clinicians arealso trainedto respond to acute diabetic emergencies. Fast action and facilitation of proper care can prove lifesaving.

5. Cardiovascular Risk Factor Management

Atherosclerotic cardiovascular disease events are the leading cause of morbidity and mortality in patients with diabetes. Retail clinicians can empower patients to contribute to their self-care and minimize the risks of adverse cardiovascular events by encouraging smoking cessation, weight control, nutrition, and healthy blood pressure.

6. Microvascular Disease Screening and Management

Because diabetic kidney disease is the leading cause of end-stage renal disease, the ADA recommended annual kidney disease screening for patients who have had type 1 diabetes for at least 5 years, all patients with type 2 diabetes, and all patients with comorbid hypertension.

Retail clinicians can perform these tests, including A1C tests and urine spot checks, in their facility and encourage patients who meet the clinical criteria for frequent testing to do so.