Managing Diabetes Effectively: What should Health Care Professionals consider?
- Deepti Kumar
- Nov 12
- 3 min read
Photo Credit: Canva
Kellie, a 57-year-old, was diagnosed with Type 2 Diabetes 5 years ago. Her life was changed
upon diagnosis. She has to worry about medications, meals, etc. It was a big lifestyle change for her. Her main worry is heart disease risk and hypoglycemia risk. Maggie, a 26-year-old, was diagnosed with Type 1 Diabetes at the age of 13. She worries about the rising cost of healthcare and medications in the US and the inaccessibility to the people who need them. These are just a few patient stories that shed light on the complexity of managing diabetes that goes beyond keeping the blood glucose levels in a normal range.
According to the Standards of Care in Diabetes, some key areas that clinicians should focus on regarding diabetes management include a comprehensive medical evaluation, a person-centric approach, assessing comorbidities, and managing obesity.
What should a Comprehensive Medical Evaluation include?
The Health Care Professionals (HCPs) should perform a comprehensive medical evaluation that includes:
Medical history, physical examination, and laboratory tests.
Assesses diabetes self-management behaviors.
Nutrition.
Quality and duration of sleep. Studies have shown that sleep can affect glycemic levels.
Guidance regarding routine immunizations.
One size fit’s all or an Individualized approach?
Historically, “one size fit’s all” was the only option clinicians had to manage diabetes in the wake of limited treatment options. With the advent of technology and improved medication options, there are better opportunities to manage diabetes in a way that is individualized. An individualized/ person-centric approach should consider the following.
Physical, psychological, social, and economic factors that influence the patient’s ability to engage with his/her diabetes for optimal management.
Establishing a care team that focuses on lifestyle management and appropriate treatment options (addressing any comorbidities).
Effective communication, goal setting via reciprocal exchange of information,
Being a good listener to patients' concerns.
Showing empathy for their concerns.
Assessment of comorbidities
Diabetes is not a standalone disease. It comes with a plethora of other diseases, including heart disease, chronic kidney disease, retinopathy, and neuropathy, to name a few. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with diabetes. The cardiovascular risk factors, such as hypertension, hyperlipidemia, and obesity, are common among people with diabetes. In addition to CVD, the risk of heart failure is at least twofold higher in people with diabetes than in people without diabetes. Adverse cardiovascular and adverse kidney outcomes, including CVD, heart failure, and Chronic Kidney Disease (CKD), often go hand in hand in people with diabetes. These three conditions are caused by metabolic risk, which is high in people with obesity and increases with rising A1C levels. Studies have shown that treatment with sodium glucose co-transporter 2 (SGLT-2) inhibitor or glucagon-like peptide 2 receptor agonist (GLP1-RA) is beneficial in people with type 2 diabetes. Hence, the clinician should consider an individualized approach to treatment options that focuses on risk reduction and improvement of cardiovascular and kidney outcomes when appropriate in order to manage diabetes effectively.
Obesity Management
Obesity is a major risk factor for the development and progression of Diabetes. Therefore, treating obesity is central to the management of diabetes. HCPs should consider
Individualized treatment strategies that include lifestyle changes, nutrition, calorie intake, physical exercise, and pharmacotherapy.
Consider a combination treatment approach for high-risk individuals.
Avoid medications that are associated with weight gain.
Prefer drugs with greater weight loss efficacy, such as Glucagon-like peptide 1 receptor agonists (Semaglutide or Tirzepatide) over metformin with lesser weight loss efficacy.
Conclusion:
Diabetes is a complex disease, and effectively managing it requires a collaborative effort of the care team. The patient’s involvement is key to improving the quality of life. With the advent of continuous glucose monitors (CGMs), Telehealth, Artificial Intelligence, nutrition, and weight management programs, the healthcare community is better equipped to deal with the challenges of providing quality care to patients with diabetes.
Sources:
Assessed and Endorsed by the MedReport Medical Review Board
