Diabetes Control

Almost half of Americans with diabetes do not meet the American Diabetes Association (ADA) recommendations for either A1c, BP, or LDL goals; 81.2% do not achieve all three.

The ADA and the American Association of Diabetes Educators provide strategies to improve diabetes care through diabetes self-management.

One framework for patient-centered diabetes self-management is the American Association of Diabetes Educators 7 Self-Care Behaviors™ (AADE7 Self-Care Behaviors™). This framework can assist providers with identifying barriers to optimal diabetes control, facilitating problem-solving, developing coping skills, and achieving optimal self-care.

The ADA Standards of Medical Care in Diabetes - 2017 provides strategies to improve diabetes care. This includes guidance on addressing food insecurity and barriers to care, as well as guidance on treating ethnic, cultural, gender, socioeconomic differences and disparities. Acknowledging and overcoming these challenges may help vulnerable populations incorporate the AADE7 Self-Care Behaviors™ into their daily lives resulting in improved diabetes outcomes.


To help you quickly reference the AADE7 Self-Care Behaviors™, the ADA Standards of Care Strategies, and access corresponding resources assembled by HUSKY Health, please consider using the information below when caring for your HUSKY patients with diabetes.

AADE7 Self-Care Behaviors ADA Standards of Care Strategies Diabetes Control Resources for Strategy Implementation

Healthy Coping

Emotional Distress:

The emotional impact of diabetes can make it difficult for patients to adopt and maintain healthy behaviors. Key opportunities for psychosocial screening occur at diabetes diagnosis; during regularly scheduled management visits; during hospitalizations; with new onset of complications; or when problems with glucose control, quality of life, or self-management are identified.1

The Problem Areas in Diabetes (PAID) Questionnaire can help you assess patients with diabetes for related emotional distress. This tool can predict future glucose control of the patient.

Problem Areas in Diabetes Questionnaire

The PAID-5 questionnaire is a validated, condensed version of the PAID questionnaire. Click here to download the PAID-5.

If your patient is experiencing diabetes-related distress, consider working with them to explore options for overcoming the identified issues.

Emotional Distress Referral options:

Healthy Eating

Food Insecurity:

Food Insecurity complicates diabetes management, especially related to adopting and maintaining healthy eating behaviors. To address food insecurity, seek local resources that can help patients and the parents of patients with diabetes to more regularly obtain nutritious food.1

To screen for food insecurity, consider using the “U.S. Household Food Security Survey Module: Six-Item Short Form” from the United States Department of Agriculture.

U.S. Household Food Security Survey Module

To assist HUSKY Health patients who experience food insecurity, consider referring your HUSKY patients to Intensive Care Management (ICM). ICM can help your HUSKY patients access local resources to nutritious food. Click here to learn more about ICM.

Taking Medications

Taking Medications as Prescribed and Managing Changing Treatment Needs:

A patient’s ability to take their medications as prescribed should be addressed as the first priority.

If adherence is less than 80%, consider problem-solving with the patient to remove barriers to taking medications as prescribed.1

Some possible barriers include:

  • Limited numeracy skills
  • Emotional distress
  • Unmet basic needs (food and shelter)
  • Limited patient activation
  • Lack of understanding

Success in overcoming barriers to adherence may be achieved if the patient and provider agree on a targeted approach for a specific barrier.1

If adherence is 80% or above and glycemic goals are not reached, then treatment intensification should be considered (e.g., up-titration). If medication up-titration is not a viable option, then consider initiating or changing to a different medication class.1

To help you assess your patient’s ability to take medications as prescribed and to identify any barriers your patient may have, consider using the “Let’s Talk About Your Medications” tool below.

Let’s Talk About Your Medications

If a patient is unable to take their medication as prescribed, consider:

  • Using the resources within the Problem Solving, Healthy Coping, and Monitoring sections of this page
  • Referring your HUSKY Health patient to ICM for additional support with resolving barriers to taking medications as prescribed. Click here to learn more about ICM.

If a patient is taking their medication as prescribed and medication is not effective, consider using the following algorithms from American Diabetes Association/European Association for the Study of Diabetes to assist with intensifying treatment.

Problem Solving

Limited Numeracy Skills:

Low diabetes-related numeracy presents a wide-reaching barrier to attaining and maintaining glycemic control. When patients struggle with this, they may make mistakes with dosing or even abandon treatment plans altogether.

A patient-centered communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care, may lead to improved participation in self-care behaviors and glucose control.1

Consider assessing numeracy skills using the Diabetes Numeracy Test (DNT5). This validated assessment tool is designed to screen numeracy skill levels in patients with diabetes. The DNT5 is available below.

Diabetes Numeracy Test

If your HUSKY Health patient has limited numeracy skills, ICM can assist them by providing additional services to improve understanding. Click here to learn more about ICM.

Monitoring

Limited understanding and activation:

When prescribed as part of a broader educational context, self-monitoring of blood glucose results may help to guide treatment decisions and self-management.1

Patient understanding is the foundation for accurate self-monitoring. Helping your patients to become an active participant in using their monitoring results is a critical step in reaching optimal care.

To assess patient understanding and activation, consider using the following resources:

  • The “Plans to change your way of life” tool provides a quick overview of a person’s readiness to change. Click here to download the tool.
  • Using the teach-back method can confirm patient understanding of care instructions by asking patients to repeat the instructions using their own words.2
  • The Shared decision-making method enables patients to be active participants in their care and make informed choices.

Reducing Risks

A1c Testing and Dilated Retinal Eye Exams

A1c Testing Recommendations

  • Perform the A1c test at least two times per year for patients who are meeting treatment goals
  • Perform the A1c test quarterly for patients who are not meeting glycemic goals or who have experienced a change in therapy.

Dilated Retinal Eye Exam Recommendations Screening For Adults

Type 1 Diabetes

  • Initial dilated and comprehensive exam within five years after diagnosis with annual follow-up dilated exams

Type 2 Diabetes

  • Initial exam at the time of diagnosis with annual follow-up dilated exams

If there is no evidence of retinopathy for one or more annual eye exams, then exams every 2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations for patients with type 1 or type 2 diabetes should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight-threatening, then examinations will be required more frequently.

Help your patients understand the importance of A1c tests and eye exams by using the handouts below with your patients. These handouts can be used to develop an action plan for scheduling and completing A1c and eye screenings on a consistent and regular basis. The English and Spanish versions of these handouts are below.


Care Coordination Services for your patients with diabetes:

Intensive Care Management (ICM) offers services to help your patients stay on track between appointments. To learn more about ICM, click here.

To refer a patient to ICM:


Diabetes-Related Reports from HUSKY Health

Gaps in Care: Adult Diabetes Reports

To help you identify patients with gaps in care related to their diabetes, HUSKY Health provides reports on HUSKY patients attributed to your practice through our secure provider portal. Gaps in Care: Adult Diabetes (Type 1 and 2) reports can help you identify HUSKY Health patients who are in need of HbA1c testing, nephropathy testing, and retinal eye exams. Follow-up with these patients is recommended to meet ADA guidelines and improve their healthcare. To access these reports, click here.

ED Utilization Reports

To help you identify patients in need of care, HUSKY Health provides reports on HUSKY patients attributed to your practice through our secure provider portal. Emergency Department (ED) Utilization reports can help you identify patients who have visited the ED for diabetes-related care and now require follow-up. To access these reports, click here.

To enroll in the secure provider portal, click here and follow the instructions.


Diabetes Guidelines


References:

1 American Diabetes Association. Standards of medical care in diabetes – 2017. Diabetes Care. January 2017; 40(Supplement 1). http://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf

2 Use the Teach-back Method. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/game-plan/talk-with-patients/teach-back-method/pages/index.aspx

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