Title : Making a difference in community setting
Abstract:
Background: Around 80% of people living with diabetes have their diabetes managed in a primary care setting. Collaboration between the client, diabetes nurse educator (DNE), diabetes dietitian educator (DDE) and primary care provider (PCP) is the key. This is a study on a care provided by DNE and DDE alongside PCPs in a Community Health Centre primary care setting 1 day/week. Antihyperglycemic agent adjustment recommendations are made to PCPs when glycemic targets were not being met.
Purpose: To assess and improve clients’ glycemia in a primary care setting.
Methods: Retrospective analysis of clients who were referred and seen by diabetes educators during a period of 2 years between January 2016 – January 2018. The HbA1C results after clients saw the DNE and DDE were compared to the HbA1C prior to being seen by the educators.
Results: A total of 63 clients were seen during a 2-year period and the HbA1C improved for the majority of the clients except 4 individuals whose lack of improvement could be due to not attending the follow-up appointment. The mean HbA1C improved from 8.5% to 6.4% (Fig1.). These results demonstrate the importance of collaboration between primary care providers, DNE, and DDE in a primary care setting in helping clients manage glycemia and improve glycemic outcomes. Some individuals did not have pre and/or post HbA1C and some of these clients did not come to follow-up appointments.
One Case Presentation: A male client in his 50s living with type 2 diabetes for approximately 20 years, eating random meals and sleeping between 6-20hours/day without clinical depression. On initial visit with diabetes educators, he was on Multiple Insulin Injection of approximately 200units/day with 20% basal and 80% bolus and taking Metformin. His HbA1C was 10.7% with not improvement in the last 4years.
Management and Outcome: At the initial visit with the DNE and DDE, he reported a recent visit to an ophthalmologist and requiring eye surgery in a month. He was advised due to his elevated blood glucose he is at risk of infection and losing his sight. DNE met with the client biweekly coaching him in managing his glycemia. DNE explored that his next motivating factor was insulin reduction, therefore, in collaboration with his Primary Care Provider (PCP) he was started on oral antihyperglycemic agents (OAAs) and thereby reducing the insulin doses. He responded well to the OAAs. As his glycemia improved, he became motivated in making lifestyle changes, reducing refined carbohydrate, increasing vegetables and activity level. Six months later, his HbA1C reduced to 7% and he required only basal insulin of 25units.
Discussion: Managing glycemia requires great effort from both clients and health care providers. Coordinated care, understanding the most significant concern of the client and acting on it are important. Education alone might not get the client to target but motivation will help to engage the client in active care and promote behavior change.
Audience Take Away:
- Registered Nurses, Diabetes Nurse Educators, Nursing Students, Diabetes Dietitian Educators.
- Presenter will discuss the strategies used to nurture the collaborative care in order to achieve the glycemic control. This can empower nurses to take active role in managing glycemia while collaborating with other health care providers. Improving glycemia in the community center will improve health and reduce admission to hospital. Also, it shows methods to motivate clients regarding their diabetes which can be used in other chronic condition.
