Changing the Conversation about Type 2 Diabetes

This article is brought to you by a diabetes prevention partnership of the Oregon Medical Association and American Medical Association.

March 12, 2018 

In the current medical system, managing and preventing chronic disease requires a strong partnership between patients and doctors. Consider the statistics around prediabetes: 84 million U.S. adults have prediabetes and 9 out of 10 don’t know it.

Part of this partnership involves having conversations with patients about their lifestyle and risk factors for chronic disease. Patients may be unaware of their risk level, and many patients have never had a physician discuss prediabetes with them. 

An effective and easy tool to help patients determine their risk of prediabetes and type 2 diabetes is the prediabetes online risk test. This one-minute screening tool quickly determines if a patient needs further testing and encourages at-risk patients to join the National Diabetes Prevention Program (DPP). Observed annually on the fourth Tuesday in March, the March 28, 2018 Diabetes Alert Day® is an excellent opportunity to suggest that patients take the test.

The DPP addresses lifestyle changes that can significantly empower patients to take control of their own health. In the case of prediabetes, it can be a reversible condition and the DPP helps prevent or delay type 2 diabetes through lifestyle modifications.

"Primary care physicians and physician assistants are uniquely poised to get ahead of this looming tide of diabetes in the population, says Dr. Kevin Ewanchyna, the OMA’s "physician champion" in the association’s efforts to target prediabetes. “While we are all adept at diagnosing and treating disease, we get equally excited when we can prevent disease in the first place. Utilization of EMR disease and screening registries can greatly minimize the impact of extra work to the physicians."

Here are three ways to have productive conversations about prediabetes and help encourage patients to take an active role in managing their health.

Let patients tell you their concerns.

By asking what matters to the patient, you and the patient are both engaged, and the conversation shifts so that you can identify the key issues that are important to your patients.

Once you identify those things, then you can best create a care plan to help patients successfully prevent type 2 diabetes. 

One tool that may help how you have these conversations is offered on a new podcast from the American Medical Association (AMA) called AMA Doc Talk. Episode 3, “Coping with chronic disease,” dives into how care teams’ relationships with their patients play a role in management of chronic disease such as type 2 diabetes.

In addition to improving conversations with patients, it’s important that you’re armed with tools that help you have these conversations.

Another useful tool to  educate your patients about the importance of diabetes prevention is the Prevent Diabetes STAT toolkit. This toolkit, developed by the AMA with the Centers for Disease Control and Prevention (CDC), provides resources to remind physicians to screen, test and refer patients with prediabetes to an in-person or online DPP.

Involve the entire care team.

The care team plays a key role in helping patients prevent and manage type 2 diabetes and other chronic disease. Developing a team-based approach allows everyone to become actively involved and share responsibility for improved patient care, and the entire practice becomes better equipped to address patients’ questions and needs.

Engaging the care team can help identify patients who may need screening for diabetes, or referral to a diabetes prevention program. The AMA has developed a STEPS forward module for preventing type 2 diabetes in practice, which includes resources to help you and your team determine roles and responsibilities regarding diabetes prevention and your practice workflow.

The pre-visit planning component of the STEPS  forward module can also help improve the efficiency of care given in order to identify all patients at risk for chronic disease who come into your office.

Consider using a health coach.

A key part of patients taking an active role in their health is ensuring that they understand their care plans and how to achieve their health goals. It’s important for patients to understand that physicians and care teams are best suited to help them actively self-manage chronic disease, such as type 2 diabetes, or prevent it from developing.

Health coaches can be great support systems that help educate patients and give them the skills and knowledge they need to participate in their own care. Making use of health coaches is also another way to continue to build strong relationships and improve the conversations you have with patients.

As a part of its STEPS forward program, the AMA has developed a module for health coaching that explains how it can be incorporated into a practice that includes case studies of how it’s been done successfully along with downloadable tools and implementation support.

The health coach may be even be part of your practice’s own diabetes prevention program or may help connect patients who have prediabetes to a National DPP in your nearby community or online. However health coaches are integrated into a practice, they can help bridge a gap between you and your patients and help engage them in actively participating in their own health.

Implementing these three strategies can help make the precious time you have with patients to discuss type 2 diabetes and other chronic disease prevention more effective, and the conversations you have more constructive and beneficial.

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