Comprehensive Management of the Patient Living with Diabetes | myNEXUS®

22 . 11 . 2021

The CDC estimates that over 34 million adults in the United States have been diagnosed with diabetes; this is approximately 13 percent of all individuals aged 18 years or older. Of all adults aged 65 years or older, nearly 27 percent are living with diabetes. Caring for an individual with diabetes involves addressing multiple factors that can affect glucose control and overall health.

Complete disease management of diabetes should include:

MEDICATION THERAPY AND EDUCATION

Many people living with diabetes will take one or more medications to achieve healthy blood glucose levels, and it is important to ensure that that the treated individual and the caregiver understand appropriate medication management. This includes knowing the correct dosage and frequency of each medication prescribed. It is also important to routinely monitor blood glucose levels to ensure that there is effective control with the prescribed treatment. Goals for blood glucose levels should be established and understood by the patient and caregiver. If it is found that glucose is poorly controlled, the pattern of glucose readings should be reported to the treating provider.

LIFESTYLE MANAGEMENT

A comprehensive management plan for a person with diabetes should include goals for healthy eating and weight. While diet directly affects blood glucose levels, both diet and physical activity contribute to changes in weight that can have a persistent influence on glucose control. Dietary counseling can help individuals living with diabetes understand the effects of food choices on their overall health. Providers and caregivers should encourage physical activity in patients who are physically able to exercise safely.

Poor diabetes outcomes are associated with economic and social conditions that can adversely affect a patient’s ability to obtain nutritious foods. These conditions can lead patients to select inexpensive, processed foods and to eat erratically. Poor access to healthy foods also can cause financial strain and mood changes that lead to poor self-care that can impact the health of patients with diabetes. When social conditions are identified that adversely affect diabetes management, the care plan should include the pursuit of community resources that can aid the patient in securing healthier food options.

PREVENTIVE MEASURES

Over time, elevated blood glucose levels gradually impair small vessels that supply blood to various organs in the body. This may increase the risk for diabetes-related complications, including:

  • Diabetic eye disease (retinopathy)
  • Kidney disease
  • Neuropathic disease and non-healing wounds
  • Cardiovascular disease

Routine screening measures can help to prevent or slow the progression of these complications. Patients living with diabetes should undergo routine eye examinations and have routine inspection of the feet. Providers with experience in wound management can address skin breakdown or open wounds and lower the risk for amputation when wounds occur on the lower extremities.

Less commonly reported complications of poor diabetes control include gastrointestinal disease, poor dental health, and sexual dysfunction. Screening for suspicious symptoms is encouraged, to consider the benefit of interventions that could improve patients’ quality of life.

 

WE CAN ALL HELP

In recognition of American Diabetes Month, now is a good time for caregivers of a person living with diabetes to ensure that appropriate treatment, education, and preventive measures are in place for optimal health. In the home health arena, myNEXUS has a team of nurses certified by the Wound, Ostomy and Continence Certification Board, and physicians certified by the American Board of Wound Management who can support efforts to treat wounds that require advanced care. Also, myNEXUS can help address social factors that may serve as a barrier to maintaining optimal health in the homebound individual.

 

SOURCES:

Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. www.cdc.gov/diabetes/data/statistics/statistics-report.html. Accessed September 29, 2021.

American Diabetes Association. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021;44(Suppl. 1):S7-S14.

American Diabetes Association. Economic costs of diabetes in the U.S in 2017. Diabetes Care 2018:41:917-928.