ADA: Using the Diabetes Educator to Decreasing Physician Workload

A nurse practitioner and clinical pharmacist-directed diabetes center improved clinical measures and decreased physician workload. 

As the prevalence of diabetes mellitus continues to increase to near epidemic levels in this country, the impact on the United States healthcare system is significant. Patients with new-onset and uncontrolled diabetes require considerable time requirement to understand the nature of the disease and develop self-management skills to prevent acute and chronic complications. Over 30 million physician office visits for diabetes are reported annually. 

Harbor Medical Associates, a multi-specialty physician group in South Weymouth, MA and CVS Health Connection collaborated to implement the Center for Wellness and Education. The center integrates medical care with diabetes education and monitoring. The nurse practitioner and clinical pharmacist, both trained as diabetes educators, provide general wellness programs, comprehensive diabetes management services including initial and follow-up physical examination, laboratory test ordering, and medication adjustment and monitoring, working together with the group's physicians. The diabetes individual and group education program incorporates behavioral change to improve diabetes knowledge, self-monitoring skills and lifestyle modification to decrease diabetes and cardiovascular risk.

Currently over 200 patients are managed with approximately 30 new referrals per month. At follow-up, participants with two or more results reported average decrease in HbA1c of 0.93% (p=0.001), decrease in systolic and diastolic blood pressure by 7.4 mm Hg (p<0.0001) and 4.2 mm Hg (p=0.001), respectively, and decrease in triglycerides by 51.7 mg/dL (p=0.04). The proportion of patients with HbA1c > 8.0% at baseline decreased at follow-up (p=0.001). Physician workload has decreased by referring patients to the center for routine diabetes follow-up. 

In summary, implementation of a nurse practitioner and clinical pharmacist-directed diabetes center improved clinical measures and decreased diabetes and cardiovascular risk while reducing physician workload.  American Diabetes Association's 62nd Annual Scientific Sessions 

Did You Know:  Supersizing The Calories
For just a little more money, fast food restaurants will give you a lot more calories and saturated fat. A survey by the National Alliance for Nutrition and Activity finds that "bargain" super-sized portions of fast food pack on extra calories and saturated fats. The organization says these oversized portions contribute to rising rates of obesity in the United States, The Associated Press reports. The survey, which looked at fast food prices and calorie and fat content, was conducted in five U.S. cities. The survey found that while a large order of McDonald's fries cost 62 percent more than a small order, it had 157 percent more calories. A large Cinnabon cinnamon bun costs only about 25 percent more than a small cinnamon roll, but has twice as many calories and three times as much fat. The AP quotes restaurant industry representatives as saying that lack of exercise is the main culprit behind obesity in the United States.