5 Ways to Personalize Diabetic Care in Family Medicine

Diabetes affects over 37 million Americans or about 1 in 10 people. Surprisingly, 1 in 5 people is unaware that they have diabetes.

Currently, the number of people diagnosed with diabetes in America is reaching a fever pitch. Despite the momentous discovery of insulin over 100 years ago, the death rate for diabetes jumped nearly 14 percent between 2019 and 2020 and continues to rank among the top 10 leading causes of death.

Current Challenges in Diabetes Management

Insulin is a life-saving medication but, unfortunately, one that is out of reach for many patients who often have to choose between their medication or their next meal. Secondly, diet and exercise are proven to improve outcomes for diabetic patients, and educating patients remains an integral focus in steering ideal outcomes.

But if dietary and lifestyle choices reign supreme when managing or even reversing diabetes, why then is there no dietary or nutrition training in medical school? How then can doctors educate patients and suggest healthier food and drink alternatives if they weren’t educated on this themselves?

Worse, challenges in the current fee-for-service model greatly limit physicians’ time with their patients. Less time with patients results in prioritizing prescriptions and procedures over patients and their preferences—making it seem impossible to build a meaningful relationship with the patient and effectively help them take ownership of and improve their health.

ChenMed’s National Director of Endocrinology, Dr. Francisco Hernandez, weighs in about the current challenges and how to personalize diabetic care in a primary setting despite the limitations of the fee-for-service model.

5 Ways to Personalize Diabetic Care in a Primary Care Setting

1. Medication will not work as effectively without a well-balanced diet. Many diabetes patients manage other chronic conditions such as kidney disease or hypertension. As a result, they are limiting salt, not eating adequate protein, and avoiding carbohydrates, leaving them with an unattainable idea of a well-balanced diet.
   
   Dr. Hernandez offers this go-to dietary tip for diabetes patients: “Start your meal with a small salad, and I don’t mean potato salad or tuna salad—but the vegetable kind. The fiber delays the absorption of carbs that follow which allow you to digest a little slower and allows your pancreas which likely already works slowly to get control of your blood sugar. The reflexes in your system tell the rest of the body food is coming which also allows you to prepare for the insulin secretion you may need for the meal.”
   
   Patients must be educated about their diet and lifestyle choices and given practical resources and suggestions that enable them to keep their conditions at bay and live a quality life. Learning and implementing these changes, especially after a lifetime of poor choices, takes time and dedication from both the physician and patient.
    
2. Prescribing medication does not mean a patient will take it properly. Doctors often feel a sense of accomplishment after writing a prescription, as if their job finishes then and there. But if the patient does not take medicine as directed, or worse, doesn’t take it at all, then writing that prescription served no purpose. And while prescribing medication to manage symptoms is undoubtedly helpful, establishing a genuine, impactful relationship with the patient often supersedes putting the pen to the prescription pad. When your patients trust you, they are more likely to be candid about any challenges they are experiencing, if they are missing or skipping doses, or not taking the medication altogether.
    
3. Primary care providers need to work with the patient to determine the best course of action for the patient—not just what looks good on paper or is right “in theory.” “Sometimes the best treatment on paper is not the best treatment in reality because it will never happen,” Dr. Hernandez shares. “For example, I would ask if they can stick to structured meal times, the same time every day, and base their insulin dosages around their schedule—but then they are not able to deviate from that. Others will inject themselves 4-5 times a day to eat whatever they want or if they are traveling. So I ask what is preferential for them and then tailor the regimen based on their [feedback and] lifestyle. Because some prefer what is most affordable and others prefer [convenience].”
   
   A one-size-fits-all approach seldom actually fits in medicine, especially when it comes to treating diabetes patients. Tailoring treatment to your patient’s lifestyle or needs can be extremely beneficial in managing their conditions.
    
4. Patients are more honest with doctors they trust, so building relationships with patients is critical. Patients who do not trust or have a foundational relationship with their doctor often omit important information that can affect treatment and health outcomes. It can also result in inaccurate diagnoses and the risk of the patient taking medication that can cause adverse effects. When it comes to managing diabetes, open, honest discussions where the patient feels heard and respected are paramount to driving positive change.
    
5. Many patients cannot afford insulin or other life-saving medications, so education about diet and lifestyle choices can be the difference between life and death. As if around-the-clock monitoring of blood sugar levels, constant cumbersome insulin injections, and living with panic and anxiety around the dangers of diabetes complications aren’t enough, the cost of insulin is unbearable for many Americans.
   
   Missing doses or not taking the medication as described can result in emergency hospital admission, further driving home the point that education is integral. The most ethical way to practice medicine is to consider cost, prescribe what is most practical, affordable, and most likely to be maintained by the patient, and make sure they are informed and equipped to carry out the treatment plan.

The Importance of a Holistic Approach and Health Education in Diabetes Management

The time and resources required to build meaningful relationships with diabetes patients under the current fee-for-service model often seem insurmountable. While most physicians went into family medicine because they wanted to save lives and be a beacon of light in their community, many did not anticipate the many siloed and bureaucratic challenges that impede them from fulfilling this mission.

At ChenMed, physicians are empowered to do what’s best for their patients—not what drives the highest profit margin. This is ethical medicine.

To learn more about decoding diabetes care and the importance of health education, listen to the full episode of Faisel & Friends with Dr. Francisco Hernandez, ChenMed’s National Director of Endocrinology. Faisel and Friends is a primary care podcast that discusses the state of healthcare in America. Subscribe now to receive the latest episodes.