Prime Time Living - Page 8 - Diabetes Boot Camp

Prime Time Living
- Page 8
Diabetes Boot Camp
MedStar heavily invests in at-risk diabetics

By Margit B. Weisgal, Contributing Writer

Even after John Smith had a heart attack and triple-bypass surgery in 2001, he ignored his diabetes. Before that, he rarely went to the doctor because there was nothing wrong. “My wife told the doctor, ‘He doesn’t have a cold; it’s something else.’ When my physician did an EKG, I was having a heart attack right in his office. For a year after that, I’d get regular check-ups but ignored the fact that my blood sugar got higher and higher. I was prescribed metformin, a medication to help lower my glucose level, but I still didn’t behave.”

Smith is typical of many diabetes patients: ignore the disease and maybe it will go away. But, of course, that didn’t happen. Instead, it got worse, with his blood sugar levels increasing constantly. “I didn’t help the situation,” he explains. “I abused everything – candy, donuts, cake – anything and everything I wanted. I loved food, especially sweets, and wasn’t going to change.”

He started seeing an endocrinologist and was put on insulin instead of just metformin. Each time he saw his doctor, his A1C would go up to 10, then 11, and it wouldn’t stay constant. “I would listen to the doctor, but I didn’t really believe anything was wrong, so I lied about what I was eating.” It went from bad to worse. And he needed help.

The solution was MedStar Pathway to Diabetes Control, a pilot program under the aegis of MedStar Union Memorial Hospital to assist the most recalcitrant diabetics get control of their disease. In 2015, the MedStar Diabetes Institute (MDI), in partnership with key MedStar Health System diabetes stakeholders, decided to figure out a way to help patients like Smith, those with an A1C over 9, far higher than the attainable goal of below 7, and had an increased risk of diabetes-related complications. Their goal was to create a program that improved diabetes care outcomes for this target group and reduced the skyrocketing costs associated with emergency room visits due to complications.

“Patients are like ostriches when it comes to their own diabetes management. They don’t always recognize their personal barriers to control the disease,” says Dr. Paul Sack, assistant chief, division of endocrinology and metabolism at MedStar Union Memorial Hospital. “Doctors can see only 15 to 16 patients, limiting how much time we can give each individual – or how much they’ll allow us to help. These high-risk patients need more care, so it has to be a team effort.”

All those involved with this program refer to it as Boot Camp because it takes place over 12 weeks and includes intensive education and behavior modification much like military training. There are three components to the program:

1. Medication management based on continuous review and management of blood sugars.

2. Survival skills – diabetes self-management education – including nutrition, meal planning basics, blood glucose targets, medications management and when to seek medical help.

3. Enhanced patient-provider communication provided by endocrinologistsupervised certified diabetes educators.

“Pathway participants start with one or two face-to-face meetings,” says Lynne J. Brecker, R.N., B.S.N., certified diabetes educator at MedStar Union Memorial Hospital. “Because these are high-risk patients, they’re often resistant to accepting that they have diabetes. Often, their lives are complicated with stressors like money, moving, even using their meters, so they think their lives are more important than their health. But the two are so intertwined they cannot be separated. When patients understand the disease, really understand it, and what it does to their bodies, they have a better shot at managing it, so those discussions can be pretty intense.”

Those first meetings also cover struggles they face with work, family or remembering to test themselves and take their medications. Brecker will demonstrate better techniques for injections, and patients are also given a new glucose smart meter that electronically submits their daily readings to a virtual command center manned by nurses and nurse practitioners. Then their medications are reassessed based on their current insulin needs.

Once they’re enrolled, the most important component for the first few weeks is the daily calls and reminders. After that, they get a phone call weekly that are like coaching sessions and having a personal cheering squad.

Because Smith’s numbers were out of control, he was a perfect candidate for the boot camp. Once he joined, he was given a new glucose smart meter to test his blood every morning. One requirement of the program was to phone in his A1C numbers every day, even though they’re also sent electronically. He’d then receive a call from a nurse practitioner to discuss what was happening in his life.

“They would say to me, ‘Your blood’s high, add more insulin,’ or ‘lower your insulin,’” Smith says. “Prior to this new meter, I gave myself the same amount of insulin every day. Meanwhile, I was still eating the wrong things and not ready to admit I was in trouble. But each time they called, they would cheer me on and coach me on what to eat, how to do better overall. Once my numbers dropped from over 11 to 7.8 and I leveled off, they didn’t need to call every day. My numbers are still sent in, but I’m much better at self management.”

Smith finally realized the impact diabetes had on his life. “When I have a cold, I can take a pill, and then it would go away. Not with diabetes. The daily feedback really helped me. The nurses would tell me what to do and why. Before this, I had to take nine needles a day. After they changed my medications, and I did a better job testing my blood sugar, I only take something once a week plus my daily shots before meals. And I’m behaving.”

He now uses the new meter all the time, and he still talks to his coaches regularly. “I’m not good with computers, so I don’t do research, but maybe I should have,” Smith says. “Doctors don’t tell you enough, but I also didn’t listen, and when I leave the office, I want a doughnut. I don’t plan to screw up; it’s my responsibility. Now, though, I see the connection between my behavior and my problems. It’s like being a drug addict: one day at a time.”

Smith plans to stay “sober” because

Bootcamp continued on page 23