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5 Keys to Good Diabetes Care

Getting your diabetes under control takes collaboration between you, your family and friends, and your health care team. Studies have shown that people respond better when they are an active part of the healthcare decision-making. That means you can’t be entirely passive in your interaction with your health care team. Your doctors know the medicine, but you know what is and isn’t possible for you. In addition, you will do better if you aren’t an island. The people who have the best outcomes have the support of their family and friends. It makes sense: Most of those close to you have your best interest at heart. But it is up to you to guide them to the areas in which you need help, and steer them away from being the diabetes police.

Here are a few ways to get you and your diabetes care team on the same page:

Treat to Target.
You may have heard this term before, but not known what it means. Treating to target is a method to focus health care providers’ attention on clinical measures; it helps them avoid clinical inertia. Did you know that only 53 percent of people in the U.S. meet their A1C goals and only 19 percent(!!!) have their blood pressure, cholesterol and A1C where they should be? Part of the problem comes from health care providers not being proactive enough. For example, if you are on three oral agents and your A1C is 9, stop kidding yourself. You need insulin.

You doctor isn’t doing you any favors by postponing the inevitable. So know your numbers and know what your goals are; if you are not there, ask your health care provider what you and he/she can do about it.

Be Patient-Centered.
The conversation has to be about you, not some hypothetical, archetypical person with diabetes, but YOU with all the barriers you bring to the table. In a treatment designed for you, the goals may need to be tweaked. For example, the American College of Clinical Endocrinologists has a goal of 6.5 percent for A1C. However, if you are elderly or have multiple other chronic conditions, 7.5 percent may be just fine. Similarly, metformin may be a wonderful drug and the first line of drug treatment for diabetes, but if you can’t leave the bathroom when you are on it, it isn’t for you.

Blood Pressure First.
The focus of diabetes treatment is on getting blood glucose in control, but, in truth, cardiac risk factors are the ones that kill. Getting and keeping blood pressure in range is one of the most important things you can do to prevent both heart and kidney damage. If your blood pressure reading is greater than 140/90 mmHG, you may want to talk with your doctor about adding or changing your blood pressure medications.

Shared Medical Appointments.
This may sound strange at first and it may not be for everybody, but sharing medical appointments has some advantages. (Physical exams are done individually.) Shared medical appointments open you up to the realization that you are not alone. Talking with others is a great way to find out the strategies that have been successful for them. Another real advantage is that you get to spend more time with your doctor. Except for the first time you meet with him or her, the average time you spend with your health care provider may be 10 or 15 minutes per office visit. Often that is barely time to remember what you wanted to talk about, let alone have a serious discussion about it. In a shared medical visit, the doctor is generally in the room for 45 minutes to 1 hour.

Follow Up.
Diabetes isn’t an ear infection. You can’t take a week’s worth of pills and eradicate it. Unfortunately, it is a life-long disease which requires that you check in on a regular basis. The health care team can’t help you if you don’t show up to your appointments. Keeping diabetes in control means you will be making doctor appointments quarterly.


What have you done to get you and your diabetes care team working together better? Have you ever gone to a shared medical appointment? Would you consider it? I'd love to hear your thoughts.

Live well and enjoy!

Nora
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