Helping Medical Students Counsel Patients With Uncontrolled Type II Diabetes: An Innovative Approach Alice Fairman Daniels, MD,MS Assistant Professor Cook County-Loyola-Provident Family Medicine Residency Program

What is Diabetes A syndrome of hyperglycemia with many etiologies A chronic illness that requires continuing medical care and ongoing patient self- management education and support to prevent acute complications and to reduce the risk of long-term complications (ADA)

What is HbA1c? Glycated Hb/glycohemoglobin/ glycosylated Hb Reflects the level of glucose control over the preceding 120 days or 3 months Normal HbA1c range: 4.0%-5.6% Pre-Diabetes: 5.7%-6.4% Diabetes: greater than or equal to 6.5% HbA1c: < 7 % is Target range for Diabetics

ABCDEF of Diabetes Tools to manage Diabetes

ABCDEF of Diabetes A:Hemoglobin A1C <7% q3mo Estimates avg BG over past 3 months & helps determine how well blood sugar has been in control Glucose(Blood Sugar) - Before Meal: Target = hrs after beginning of meal=<180

ABCDEF OF DIABETES B: Blood Pressure: Target is 130/80 or less Check at every visit BP: The pressure of the blood against artery walls. High BP can damage arteries and organs. Pt to ask for BP results

ABCDEF OF DIABETES C – Cholesterol: Total target is (<200) LDL: < 100 Less than 70 if existing heart disease Lipid Panel: yearly HDL: – Male > 40 – Female > 50 Triglycerides: Less than 150

ABCDEF OF DIABETES Damage to kidneys: Albuminuria: Checks for Kidney Damage Target Value: <30 Done Yearly

ABCDEF of Diabetes Eye Exam: To check if Diabetes caused any damage to your eyes. Yearly.

ABCDEF of Diabetes Foot Exam: Remove socks & shoes Visual Exam: Every visit Comprehensive Exam Patient Exam of Feet

Depression As A Hidden Comorbidity In Type II Diabetes Mellitus Patients with Diabetes have increased risk of developing Depression Patients with Depression have a greater chance of developing Type II Diabetes Use Depression Screening Test as a tool to screen for this disease in Type II Diabetics (Center for Epidemiologic Studies Depression Scale-10)

Diabetes and Depression Can Be Treated Together Difficulty in managing Diabetes can be a stressor and eventually leads to depressive symptoms and Depression Potential stressors Effectively managing Diabetes can have a positive outcome on Depression and vice versa

Depression and Diabetes Depression can lead to: – Weight gain – Sedentary lifestyle – Decreased exercise – Poor Lifestyle Decisions

HEALTH LITERARCY

Long Term Outcomes : Patient Centered Use PCMH Model Educate students to: Check each visit Teach correct method to check blood sugars and record on blood sugar Record and review at each encounter. Prevent/Decrease incidents of: Diabetic Retinopathy, Ketoacidosis, Nephropathy, Polyneuropathy and Necrobiosis Lipoidica

Methods To Increase Student Awareness of Type II Diabetic Complications 1. Give Handout for student on Standards of Care in Diabetes by ADA. 2. Lecture on Diabetes 3. Student to Participate In Diabetic Group Visit Teaching and PCMH Diabetic Teaching 4. Compile Roster of Type II Diabetic patients in my office with known Diabetic Complications attributed to this disease for student to examine during patient’s office visit 5. Student to spend 2 days in Podiatry Clinic observing and examining patients with Diabetic Foot Problems.