ADA 2019—4 guiding principles for diabetes management in primary care

  • International Clinical Digest
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The following is the transcript from an  onsite interview  with Dr. Neil Skolnik and Dr. ­­­­­­­­­­­­­­­­­­­Jay Shubrook at the 79th American Diabetes Association Scientific Sessions held June 7-11, 2019 in San Francisco, California. The transcript has been edited for clarity.


Neil Skolnik, MD: I’m Dr. Neil Skolnik here at the 79th American Diabetes Association Scientific Sessions. I just listened to a fantastic series of discussions titled, “How Do We Focus on Consensus Rather Than Controversy, Guiding Principles for the Care of People at Risk for Diabetes.” And with me is Dr. Jay Shubrook, Professor of Family Medicine at Touro University, who gave an excellent talk on this topic from the perspective of family medicine. Welcome, Dr. Shubrook.


Jay H. Shubrook, DO: Thanks for having me.


Skolnik: Will you tell us about how you came at this topic from a family medicine, primary care perspective?


Shubrook: Sure. As we all know, working in primary care today is quite hard. We have competing agendas. We never have enough time. There are always conflicting priorities. And diabetes, specifically, is even harder. It’s a complex disease and patients usually come in with other concerns. I’m trying to find out how we can use the guiding principles in primary care to help us, and to help our patients achieve greater success.


Skolnik: I think that diabetes is the most complicated, common thing that we take care of in primary care. What are some of those principles that we can approach diabetes with?


Shubrook: I think there are a few things.


One is knowing when to screen. We should be screening our patients regularly. And for us, it’s all adults above the age of 45, independent of risk factors. But, most of my patients have risk factors long before age 45. We should be screening patients who are overweight, obese, have dyslipidemia, or have hypertension. Trying to catch this disease early would be one of the principles.


A second principle involves referring them to evidence-based programs like the Diabetes Prevention Program.


A third principle is utilizing diabetes self-management education and support early and often for someone with diabetes.


Finally, we want to engage team-based care; we should get a team involved in our patient’s care so that we don’t have to go it alone.


Skolnik: I have 2 thoughts on this. One, we try to remember that long list of criteria for patients who should be screened below age 45. And like you said, the truth is that it’s most of our patients. Very few people are not overweight and not sedentary, so we should be screening most people. Two, there’s enormous promise now when we catch people with prediabetes, and we’re doing that a lot better now than 10 or 15 years ago. I love the idea of addressing prediabetes so we can change the trajectory of someone’s illness.


Shubrook: For sure. Even though screening has improved, we’re not getting people to these evidence-based programs enough. I think of the burden that we have when we do lifestyle counseling for our patients. We have resources available to help us, so we don’t have to do it by ourselves. In fact, it’s better when we engage the team. It’s better when we get them to a Diabetes Prevention Program or get them diabetes self-management education support.


Skolnik: That’s a good point. Our listeners can go to the CDC’s website, type in “Diabetes Prevention Program,” and enter their zip code to find the nearest program.


Shubrook: Absolutely. These programs are largely covered by insurance now. It’s a mandated covered benefit for Medicare. I’m in California, so our Medicaid program is a mandated covered benefit for Medicaid. There are also many private insurances that allow this program to be fully covered as a benefit without even copays.


Skolnik: Fantastic. Any final thoughts?


Shubrook: I think family medicine and primary care is hard. Utilize your team. Get support. It’s better for you and it’s better for your patient.


Skolnik: Thank you, Jay. I’m Neil Skolnik for Univadis, here at the 79th American Diabetes Association Scientific Sessions.


Neil Skolnik, MD is a Professor of Family and Community Medicine at Sidney Kimmel Medical College, Thomas Jefferson University, and Associate Director of the Family Medicine Residency Program at Abington-Jefferson Health.

Jay H. Shubrook, DO is a Professor in the Primary Care Department and a Director of Diabetes Services at Touro University California, College of Osteopathic Medicine.