CME: Strategies for Improving Diabetes Care

CME: Strategies for Improving Diabetes Care
Author Information (click to view)

Alka Kanaya, MD

Alka Kanaya, MD
Professor of Medicine, Epidemiology, & Biostatistics
University of California, San Francisco

Alka Kanaya, MD, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

Figure 1 (click to view)
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Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  1. Explain the importance of a patient-centered approach to managing diabetes.
  2. Discuss the Chronic Care Model as a means for improving the quality of diabetes care in the United States.
  3. Review the key objectives of the National Diabetes Education Program.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwNov4.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Alka Kanaya, MD
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
 
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Alka Kanaya, MD (click to view)

Alka Kanaya, MD

Alka Kanaya, MD
Professor of Medicine, Epidemiology, & Biostatistics
University of California, San Francisco

Alka Kanaya, MD, has indicated to Physician’s Weekly that she has or has had no financial interests to report.

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With the epidemic continuing to burden healthcare systems throughout the country, efforts are needed to encourage clinicians to use patient-centered strategies and evidence-based treatments when managing type 2 diabetes. Proactive engagement and linking patients to supportive care are paramount.
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According to the most recent estimates, more than 29 million Americans—or slightly more than 9% of the population—have diabetes. Nearly 2 million new cases of diabetes are diagnosed each year, highlighting the need for greater prevention efforts. When managing patients with diabetes and those at risk for the disease, the American Diabetes Association recommends that clinicians strive to provide patient-centered care, consider diabetes across the life span, and serve as advocates for patients with diabetes.

“A key management strategy for patients with diabetes is to recognize that one size does not fit all,” says Alka Kanaya, MD. “When following evidence-based guidelines for managing the disease, it’s important to adapt care based on each individual patient’s specific characteristics.” Because patients with diabetes are also at higher risk of heart disease, a patient-centered approach should be used. This includes a comprehensive plan to reduce cardiovascular risk by addressing blood pressure (BP) and lipid control, smoking cessation, weight management, and healthy lifestyle changes that include adequate physical activity.

Fragmented Care Delivery Systems

In addition to taking a patient-centered approach, improving coordination between clinical teams is critical as patients pass through different stages of life. “Ongoing efforts are needed to prevent the complications that can occur in patients with type 2 diabetes,” Dr. Kanaya says. “Studies suggest that there has been steady improvement in the proportion of patients achieving recommended levels of A1C, BP, and cholesterol in the last 10 years, but many patients still do not meet their personal targets. Variations in quality of diabetes care have persisted, indicating that there is potential to improve care delivery systems.”

A major barrier to optimizing care is a delivery system that is often fragmented, highlighting the need to use collaborative approaches to managing patients. The Chronic Care Model (CCM) has been shown to be an effective framework for improving the quality of diabetes care and is recommended by the American Diabetes Association (Table 1). The CCM model advocates moving from a reactive to a proactive care delivery system in which planned visits are coordinated through a team-based approach. The CCM also involves self-management support, decision support, and community resources, among other features. “It’s important to clearly define the roles of clinical staff and promote self-management practices,” adds Dr. Kanaya.

The National Diabetes Education Program’s 3 Key Objectives

The National Diabetes Education Program (NDEP) maintains an online resource to help clinicians design and implement more effective healthcare delivery systems for those with diabetes. The NDEP outlines three specific objectives for clinicians: 1) optimize provider and team behaviors, 2) support behavioral change for patients, and 3) change the care system (Table 2).

To optimize provider and team behavior, the care team should prioritize timely and appropriate intensification of lifestyle and/or pharmaceutical therapy for patients who have not achieved targeted A1C, BP, and cholesterol levels. Goals should be set explicitly with patients and language or cultural barriers to care should be identified and addressed.

A systematic approach should also be set to support and educate patients with regard to behavioral changes. “We should harness technology using text messages, applications, and the electronic health record as tools to help patients when they’re outside the care of their clinicians,” says Dr. Kanaya. “Technology can help with various aspects of diabetes care, including healthy lifestyle changes, self-management, and prevention of complications.” Attention should also be paid to the emotional concerns that patients with diabetes may experience.

To improve quality of diabetes care, the American Diabetes Association recommends that institutions redesign the care process to actively advocate for patients. “Patients should be educated about their disease and efforts should be made to remove potential financial barriers,” Dr. Kanaya says. “Reducing out-of-pocket costs for education, self-monitoring of diabetes-related complications, and medications is important. As a whole, we’re behind the curve with regard to optimizing diabetes management. We need to take a more organized, systematic approach and involve a coordinated team of dedicated professionals in which patient-centered, high-quality care is the top priority.”

Meeting Diabetes Treatment Goals

Despite the best efforts of healthcare providers, some patients may still not achieve desired treatment goals. When such cases occur, Dr. Kanaya says it is important to reassess treatment regimens to identify any potential barriers to reaching therapeutic goals. Potential barriers include income, health literacy, diabetes-related distress, depression, and other competing demands. It is also important to consider patients’ culture and tailor management strategies. In some cases, referral to a medical social worker for assistance with insurance coverage and behavior assessments may be helpful. “Ultimately, we need to take a holistic approach and make every effort to prevent diabetes complications before they emerge,” says Dr. Kanaya.

Readings & Resources (click to view)

American Diabetes Association. Strategies for Improving Care. Diabetes Care. 2015;38:S5-S7. Available at: http://care.diabetesjournals.org/content/38/Supplement_1/S5.full.

American Diabetes Association. Standards of Medical Care in Diabetes—2015. Diabetes Care. 2014;38:S1-S93. Available at: http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/Documents/January%20Supplement%20Combined_Final.pdf.

Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med. 2013;368:1613-1624.

Stellefson M, Dipnarine

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