Providing Comprehensive Diabetes Care in Smaller Communities

Diabetes is a growing epidemic and is now the sixth leading cause of death in the United States. With death rates two to four times higher among adults with diabetes than among those without, as well as medical expenses double their non-diabetic counterparts, diabetes presents major health and financial concerns. Since 1991, the number of diabetes diagnoses among adults ages 18 to 79 has nearly tripled as a result of obesity, lack of exercise, and the aging U.S. population, according to the National Diabetes Surveillance System.

In the adult population diagnosed with diabetes, only 57.4 percent report ever attending a diabetes self-management class while 68.5 percent report having an A1c — a test that gives you a picture of your average blood glucose (blood sugar) control for the past two to three months — checked at least twice per year.

However, health care law is rapidly changing and acts such as the Affordable Care Act are increasing access to diabetes resources and education. If deemed strongly recommended (graded “A”) or recommended (graded “B”) by the U.S. Preventative Services Task Force, preventative services such as type 2 diabetes screening, diet counseling and blood pressure screening are covered with no cost sharing. Medicare (traditional Medicare and Medicare Advantage plans) benefits include diabetes self-management training (DSMT) and medical nutrition therapy (MNT) in an effort to prevent or decrease the incidences of comorbidities — two or more coexisting medical conditions or diseases — in the diabetic Medicare population.

Nationwide, diabetes resources are underutilized. As nutrition professionals, it is our job to help reverse these statistics and gain control over the diabetes epidemic. While many communities offer approved DSMT programs and employ registered dietitians, diabetes nurse educators and certified diabetes educators, the programs often lack volume of patients and medical provider support. Developing comprehensive diabetes care in a patient-centered model, however, is one successful means of driving change.

In recent years, medicine has transitioned to the patient-centered model, which empowers patients to be more active and engaged in their health care by improving communication, aligning objectives across the disciplines, providing information and encouragement to the patient, and providing effective and efficient health care. One way in which the patient-centered model has been implemented into health care is by way of shared medical appointments (SMAs), which have shown best outcomes among the more complex patient with multiple comorbidities, such as the diabetic patient. While SMAs take longer, the involvement of multiple disciplines allow for sharing a patient’s plan of care with not only the patient, but also the entire health care team.

Even without SMAs, it is possible to create comprehensive diabetes care for patients while maintaining a fairly traditional out-patient setting. Point-of-care A1c testing has enabled providers and diabetes educators to provide feedback and make changes to the plan of care almost instantaneously. After meeting with their provider, patients can see a diabetes educator in the exam room or a nearby location, allowing additional education, clarifications on plan of care, and a goal-setting plan to keep patients motivated and working toward defined objectives.

Having diabetes educators on-site improves patient compliance with their treatment plan, increases revenue and, most importantly, improves patient outcomes by achieving tighter glycemic control. Additionally, patients perceive intensified care. This model not only supports follow-through and relationship building with the patient, but it is perfectly suited for the intimate, smaller community setting. Develop strong relationships and rapport with medical providers to build a solid, interdisciplinary, comprehensive diabetes program that leads to improved outcomes for patients and health care facilities alike.

Nicole Morrissey on BloggerNicole Morrissey on FacebookNicole Morrissey on PinterestNicole Morrissey on Twitter
Nicole Morrissey
Nicole Morrissey, MS, RD, BC-ADM, is a registered dietitian, diabetes educator, and author of the new cookbook Prevention RD’s Everyday Healthy Cooking. Read her blog at and follow her on Facebook, Twitter and Pinterest.