Diabetes Information Best Shared By Patients and HCPs Alike

Feb 16, 2016
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Woman, 58 years of age, history of PCOS, prediabetes, strong family history of type 2 diabetes, cardiovascular disease and obesity. This patient lives a healthy lifestyle, including a lower carb meal plan, is very active, and keeps her weight down. Those interventions did not lower her A1C, so she educated herself and asked her NP/CDE if she should start metformin. This was about 20 years ago. Since starting metformin, A1C is in the 5.1-5.5% range. Patient regularly checks glucose, which was recently rising. A1C rose to prediabetes range again. Started on GLP-1 by NP/CDE. Patient then went to a new PCP who told her she should not be taking metformin or the GLP-1 because she does not have diabetes. Wanted to refer her to an endocrinologist. Patient continued with her NP/CDE, metformin, GLP-1 and healthy lifestyle. Glucose levels for the most part back to less than prediabetes levels (fastings less than 100mg/dL, and post prandials <140mg/dL). Patient was not against going to endocrinologist, but had done enough study on her own to know her NP/CDE was right on. She stayed with her NP/CDE, but she decided to change PCPs to one she thinks better understands prediabetes, will work with patient and allow more shared decision making.

Lessons Learned:

The field of medicine is changing. Both patients and healthcare professionals besides physicians have the opportunity to be better informed than in the past.
Just like type 2 diabetes, prediabetes is common, but not a condition that should be ignored or treated lightly. There are not enough endocrinologists in the U.S. to see every person who has prediabetes or type 2 diabetes. Healthcare providers need to keep up with current treatment and recommendations.
Refer patients to diabetes education or provide the information they need to know to help them make informed decisions.
Use the shared decision making process with your patients. This includes keeping yourself and your patients educated. It is our patients who live with their prediabetes or diabetes 24/7.

Joy Pape, FNP-C, CDE

Associate Medical Editor, Diabetes in Control

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