Diabetes Prevention Interview: Dr. Kevin Ewanchyna

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

June 18, 2018   

EwanchynaName: Dr. Kevin Ewanchyna
Title: Practicing physician in the state of Oregon
Specialty: Family medicine
State Medical Society: Oregon Medical Association (OMA)

What would you like members to understand about diabetes prevention?

One of the key take-home items that I would want members to understand is that the condition of prediabetes is completely reversible—and we can’t say that about a lot of other medical conditions that we treat. Chronic disease has become such a burden to the American public and a strain on the healthcare system, but with the National Diabetes Prevention Program, we have a chance to actually reverse this burden and actually prevent it from occurring in the first place. So that’s one of the most exciting things and a real key take-home message that I want members to understand.

What role do physicians and healthcare teams play in diabetes prevention?

The biggest role that physicians and healthcare teams can play in diabetes prevention is that of awareness, screening, and then education and referral. Today, 84 million adults have prediabetes, but the shocking statistic is that 90 percent of these people don’t even know they have a treatable and reversible condition. Another way to look at these figures is that one in three adults today has prediabetes, and that ratio changes when you actually look at the Medicare population, which is 65 years and older, this ratio actually increases to one in two people that have prediabetes. But again, the staggering statistic is that 90 percent of these people don’t know they have this condition that is completely reversible.

What type of impact do you feel physicians and care teams can have in helping stem the tide of type 2 diabetes?

That is key. And the biggest impact that physicians and care teams can have in helping stem the tide of type 2 diabetes is going to be screening of that 90 percent that have prediabetes but that today do not know it. And if we raise awareness and then screen our patients, we’re then better able to refer them to others that are trained in the National Diabetes Prevention Program model. We often feel as physicians that we have to own and take control of everything, but we can actually refer on to people that have this training and can get patients into a normal sugar range. And if we don’t get ahead of this curve, I really see a problem with current practices where we’ll start to see a 32 percent increase in the number of patients with diabetes who are entering our clinics. And currently today, there is such a strain on access to services that you can see this would put an even bigger strain on physician practices. So the biggest impact physicians and care teams can have is doing that screening of the population through education and awareness.

How can members become invested in helping address diabetes prevention in their patient population?

This is an area that both the American Medical Association and the Oregon Medical Association have done a lot of work. And members can become invested in helping address diabetes prevention by raising awareness through a simple act of hanging informational posters and informational handouts that are available by the AMA. And these can all be downloaded from http://preventdiabetesstat.org. And what’s really exciting in the nation is that there’s now going to be videos and posters that are available for physicians to use in their practices through the very first consumer awareness campaign on prediabetes. And this is through a partnership with the American Medical Association, the Centers for Disease Control and Prevention, the American Diabetes Association and also the Ad Council. And here in Oregon, we’re assisting Oregon physicians through a variety of educational sessions, resources and handouts that are all available at our website: http://theOMA.org/DPP.

What additional steps has your medical society taken to spread awareness around diabetes prevention?

Additionally, I have been the physician champion for the OMA for the National Diabetes Prevention Program. And today [editor: May 29] we will be having the fourth of four live sessions that have been done in partnership with HealthInsight to help educate and disseminate information on the National Diabetes Prevention Program to practicing physicians, dietitians and other healthcare providers. And these live session have been quite well attended, but I would say the biggest barrier today is still getting information and education in front of busy physicians who have their day filled with seeing patients. Any time they leave for an educational event, they’re leaving during that part of the day where they could be catching up on their charting, or they could see patients, and that’s one of the biggest barriers that I see today.

How effective have those methods been?

We’ve been keeping numbers on the people who are attending, and they have been giving us their names and email address. So it’s our hope that we can regroup with them later to ask how they have been dealing with implementation of any of the screening programs. We don’t have any data today because this is the fourth of four educationals through the partnership with HealthInsight, but we’ll be connecting with them later to see what type of data we can pull out for these activities for those who have attended these educationals.  

What tools do you believe members will find most useful in helping patients prevent diabetes?

The tools that will be the most helpful in helping patients prevent diabetes are the ones that have already have been developed. I always agree, let’s not reinvent the wheel, but let’s use the things that have good thoughts and foresight into it.  And this information again is available at the AMA via http://preventdiabetesstat.org, and again, for OMA members at http://theoma.org/DPP. But often for the future, there could be incorporation of these videos, social media campaigns, and one of the best ways for tools like this to be successful is to incorporate the awareness in screening of prediabetes into the existing workflows within physician practices. So we could be utilizing use of EMR prompts, use of prediabetes screening blood tests prior to office visits, the use of EMR registries. It’s how we use our electronic medical records smarter and not making us work harder. Work itself cannot solely rest on physicians, but also nurses, CMAs, health coaches and health navigators within our practices and communities can all be part of this workflow.

If you are using specific tools for diabetes prevention, how effective have you yourself found these tools and what would you recommend to your members/peers?

If I’m going around to the communities talking about best practices, I need to try this myself as well and see how it works. So I actually did this with a patient. And one of the most effective tools I have personally found with this patient, and this was a couple of weeks ago, the patient I knew had prediabetes, and it was a less than 20-second communication that basically stated: ‘You have a condition called prediabetes, and it is serious. It raises your risk of heart attack and stroke and poses a high risk of eventually progressing to full-blown diabetes. But, there is hope. This condition is completely reversible. So let’s get you referred to a program that I know can help.’ That basically took me less than 20 seconds to say, but success in the program and 20 seconds now, and it will be worth the time and expense of treating that same patient for diabetes itself later on. 

What aspect of diabetes prevention for your patients is the most daunting for you? Any ideas for improving?

Right now modern day practices are so extremely busy. We have patient access issues, and so for me, the aspect of diabetes prevention, when we have anybody talking about it, the most daunting for me is that thought of needing to do one more thing. We’re already very busy with data entry, entering EMRs, we manage various screenings through the United States Preventive Services Task Force, and this is another one of those screenings. We manage chronic disease. We participate in MIPS, and you can see that the practice day is really chock full already. So the best role that I can really serve is that 20-second communication that I just did for the patient. Then let others on the healthcare team facilitate that referral then to the National Diabetes Prevention Program. I feel another key role that we could do and incorporate is that of follow-up and advocacy for the patients. And we can set our email in Outlook or in electronic medical records to send a quick email update to patients that have been referred, letting them know that we’re aware of their participation in the National Diabetes Prevention Program; we’re also here for them, and I’ve found that that can be a really quick boost to the morale. Patients want to know that we’re supportive of them, and we could use our technology to send them prompts so that they get these electronic prompts from our office, and they could increase that through our email addresses. 

What would you like patients to understand about diabetes prevention?

So the biggest thing here for patients to understand about prediabetes is that it’s a completely reversible condition and that there is help, and there’s evidence and data that supports this help, that a structured program like the National Diabetes Prevention Program can actually reverse prediabetes. And this can slow down or halt the eventual progression of chronic disease that has known much morbidity, mortality, cost and strain on our current healthcare system. And for me knowing that one in five healthcare dollars is spent today on diabetes itself, what else could we as physicians, and as a nation, be able to do with those extra healthcare savings?

v2 2016