How to optimize diabetic care

Excerpted from page 14 of the November 2018 edition of AOA Focus.

More than 100 million U.S. adults now live with diabetes or prediabetes, a condition that if left untreated could result in type 2 diabetes within five years. That's an enormous burden on the American health care system, and one that won't improve without a concerted effort on the part of every medical discipline involved. As frontline, primary eye care providers, doctors of optometry are well positioned to make an impactful and lasting contribution.

Every day, patients with diabetes—or those at significant risk of developing it—are in optometric practices, representing a momentous opportunity for doctors to provide more tailored, comprehensive diabetic care. It's not an evolution that happens overnight, but it's one that optometry is suitably trained and capable to provide. Consider these three tips to position your practice for another level of care.

1. Speak up.

Start with open lines of communication, both internally and externally. When talking with patients about managing their diabetes, Tina MacDonald, O.D., suggests using a "motivational interviewing technique" rather than simply "talking at" the patient. "Express and show empathy, support and develop discrepancy in behavior and outcome, deal with resistance appropriately, support self—efficacy and develop autonomy," Dr. MacDonald says. Likewise, it's important to communicate with other members of the health care team. Encourage an open dialogue with the patient's general practitioner, internist, nephrologist or other care provider, and share your findings to help coordinate care to the patient's benefit.

Access the National Diabetes Education Program Pharmacy, Podiatry, Optometry and Dentistry (PPOD) Toolkit. This guidance shows practitioners how they can work with each other and other members of the health care team to promote better outcomes, and includes tips for communicating with patients and other providers, how to collaborate and refer among professions, and additional resources.

2. Step up.

Helping a patient understand the need to check blood glucose at least once daily and what types of action to take when results are high or low is a critical step in the management of patients with diabetes. Therefore, doctors should be open to point-of-care-testing in their practice and be open to Clinical Laboratory Improvement Amendments (CLIA) program enrollment and certification, Michael Duenas, O.D., says. "Importantly, this may provide you, the laboratory director/health care provider, and patient, quicker test results and allow you to make better clinical management decisions," Dr. Duenas says. Real-time bloodwork results can help doctors better illustrate the importance of self-monitoring and glycemic control among patients, and can be beneficial for reconnecting sub-optimally controlled patients with their primary care providers.

 More information on how to apply for a CLIA certificate.

3. Listen up.

As the diabetes epidemic continues to grow, so too must optometry's responsibilities, and that means hearing out new ways to provide meaningful, effective care. Be open to the latest research and continuing education, and consider the role of diabetes education for yourself and your patients. A. Paul Chous, O.D., says there is a huge role for diabetes education in the optometric practice. "Doctors of optometry don't need to become certified diabetes educators (CDEs) to do a fabulous job educating patients, but becoming a CDE or collaborating with one might make sense depending on patient demographics," Dr. Chous says.

For more clinical guidance on diabetic eye care in the optometric practice, access the AOA's evidence-based clinical practice guideline, Eye Care of the Patient with Diabetes Mellitus.