If you’re one of the millions of people living with type 2 diabetes, my guess is you routinely see your primary care provider to manage your diabetes. Those of us in primary care are responsible for about 90% of all diabetes care in the U.S. – the reality being there simply aren’t enough diabetologists (diabetes specialists) or endocrinologists to go around. We also are facing a shortage of primary care physicians, so the term “provider” includes our nurse practitioner and physician assistant colleagues.
It wasn’t that long ago, as recently as the 1950s and 1960s, that most primary care providers took care of acute illnesses and injuries. Strep throat, pneumonia, gout, sprained ankles, etc. Fast forward to 2019 and 70% of our typical day is spent managing chronic diseases such as hypertension, lung and heart disease, psychiatric diseases and yes, diabetes. We have had to evolve the way we approach our day and how we manage the chronic diseases amidst any acute complaints or other issues facing our patients.
It doesn’t help that the diabetes epidemic continues to grow, threatening to overwhelm our current medical system. Underserved areas struggle to provide adequate care for the increasing number of patients with the disease, and access to providers and affordable medication remain a challenge. This is particularly true in the southeast where I practice, affectionately known by the CDC (Centers For Disease Control) as the “Diabetes Belt”. In many of our rural areas, access to diabetes care is still an issue.
Gloomy, huh? Well before you get all depressed and abandon this article, let me tell you some of the good news. While living with diabetes will never be easy, there has also never been a time when we have so much insight and knowledge about how to manage the disease. This knowledge coupled with new therapies and technology can allow you to thrive despite having diabetes.
We are now learning that some of the newer medications not only help to control your blood sugar, but also can assist with weight loss and lowering of your blood pressure. Recent studies demonstrate that some classes of medicines can lower the risk of heart attack and stroke, and may provide benefits for your kidneys as well. In addition, there are new sensors that can be worn which can help you track glucose levels better and save wear and tear on your sensitive fingertips!
Go to any large medical conference where primary care providers are gathered and you will see and hear lectures on the new information in type 2 diabetes. Managing this disease occupies so much of our day and affects so many of our patients that it really is incumbent upon us to keep up. But also remember, we have to stay abreast of the evolving progress of other disease states as well, so it’s difficult to be an expert in any one discipline.
This is where you come in. Hopefully you have a great relationship with your provider, someone you feel comfortable with asking questions and getting answers, someone who knows you as an individual and understands your unique circumstances – allowing you to be in a “no judgment zone”. This includes work, family and other issues that are important to managing your diabetes. We WANT you asking questions and getting answers. We are happy to discuss just about anything, and if we don’t know the answer, we know where to get it. The best visits with my patients occur when they come prepared with their prioritized questions (please not 12 of them!) and we can get right down to the most important issues. “By the way, I’ve been having chest pain or my foot has turned black” should not be something I hear about as the visit is wrapping up.
I encourage you to learn as much about your diabetes as you can. Have you been to a certified diabetes educator? Have you sought advice from a dietician? These members of the treatment team are an invaluable resource. They are expertly trained and may have considerably more time to spend educating you about your diabetes. Please take advantage of reliable online resources such as TCOYD, the American Diabetes Association (ADA), the American Association of Diabetes Educators (AADE) and others, to learn about new medications and therapies. Be actively accountable in the management of your diabetes – take control.
Hold us accountable as well. Be sure we are communicating clearly and that decisions about your diabetes are being made together. The whole concept of “shared decision-making” is at the heart of the ADA guidelines for managing this disease. And these are decisions about monitoring, exercise, and diet, as well as medications. Let’s come to an understanding about what you are able and willing to do, and let’s not shy away from the difficult conversations. Maybe it’s just a small change that we start with. Ultimately we should set short-term and long-term goals for your diabetes journey.
At the end of the day, the partnership between patient and provider is at the center of all diabetes management. Open and honest relationships and communication lay the groundwork for long-term success in the management of diabetes. I value the relationships I have with my patients. Nothing gives me greater pleasure than seeing a patient with diabetes who has had a recent victory, and nothing gives me greater incentive than helping them through times of struggle and setback.
Remember … this relationship is all about you.