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Nonetheless, if you talk to professionals in the field, they seem undaunted. Those in the trenches know the obstacles and problems well, and in many cases have devised creative solutions. So we asked attendees at the American Association of Diabetes Educators (AADE) annual meeting:
What is the greatest challenge you face in caring for patients with diabetes, obesity, and cardiovascular disease?
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Especially for the newly diagnosed patients, it's getting over the denial that they have the disease and starting to take care of themselves. Many of them have been told over the years that they are borderline. When they think of borderline, they think, "Phew, I don't have it. I dodged the bullet." They really do have the disease, the beginning stages of it. I always tell them that borderline is like being a little pregnant. You have it, you just aren't far along. It needs to be treated right away, which means checking blood sugar on a routine basis and always following up with the primary care provider to make sure things are going okay.
People who are newly diagnosed don't want to hear that they have diabetes. Nobody does. Nobody's ever said, "Yippee, I have diabetes." Denial is a major problem in the initial stages after somebody is diagnosed.
Jacquelyn Gaddy, RN, MSN,
CDE
Diabetes educator
VA Medical
Center
St. Louis, Mo.
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I see lifestyle changes and compliance issues as the hardest things to get across to people. It requires a lot of fortitude on their behalf to make those changes, especially with patients who are diagnosed late in life and are pretty much set in their ways—getting their exercise, changing their diet. It's difficult.
What I've found is that in most cases you don't get them to change their lifestyles. You give them direction and guidance, and they take a stab at it. Most of the time. The only time you see dramatic change in somebody's lifestyle is when they've been scared to death. When they're at death's door, they wake up and realize that they have to do something differently if they want to stay around. Especially the cardiovascular patients. I see a lot of changes in them because they are scared to death. Diabetes is a little different because it can be hard to see what you're trying to tell them. They don't see the end stages of the disease. A person who has had a heart attack has knocked on death's door. They hear you a little better.
Kenric Stephens, RPh
Pharmacist
Andrews Air Force Base
Camp
Springs, Md.
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The biggest challenge is getting people to understand how diabetes affects their whole body when they are feeling well. A person who is recently diagnosed may feel very well and is not willing to make changes. Even people with higher blood sugar can feel pretty well. It's just denial. They see their results, they see what their [glycated hemoglobin] A1C is; they just don't want to have to change.
We can start to change this with education and working with people to find out what they're willing to change. I think that has a big impact on people, showing them that they're still in charge. A lot of people feel that they're out of control when they develop diabetes.
Marguerite McKenna, RN, BSN
Diabetes educator
St. Agnes
Hospital
Baltimore, Md.
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The biggest challenge in my area, southwest Pennsylvania, is access to diabetes education. We have a lot of lower-income patients, below the poverty level, a lot of elderly patients who have difficulty getting access to education. A lot of people can't afford education, and other people don't have the ability to get where they need to be.
I'm afraid to say our county has the highest incidence of lower leg amputation in the state. There is only one diabetes education program in the county. The biggest challenge to me is getting people to the program and getting them the information that they need on the level that they can understand.
Hopefully, by our working with doctors, they'll be more receptive to our help, so that we can help their patients do a little better with their management. I'm thinking of targeting a few of the physicians who have the bigger referral base of patients and offering to come in for a day at their offices. Most physicians don't have a big staff to give patient education. Hopefully, by showing them what we can do, we may be able to encourage them to refer patients.
Patricia Johnson, RN, BSN, CDE
Diabetes nurse educator
Albert
Gallatin Home Care,
Uniontown, Pa.
The biggest challenge is in gettting patients to return for ongoing diabetes education. Initially they don't feel real bad when they're first diagnosed, so they tend to come for the first visit and then not do any follow-up. We end up seeing patients later on, when they've had some kind of crisis or event. So the biggest challenge is getting them to continue on, to take responsibility and manage their own disease.
Lynne Hartwig, RN, BSN, CDE
Diabetes educator
Mercy Diabetes
Center
Janesville, Wis.
The biggest problem I see is finances. It seems that in this day and age, our patients are now trying to negotiate—do they pay for their medicine, or get healthier foods, or go to the clinic for follow-up with their doctor? Our biggest struggle right now in the community is trying to help patients with pharmaceutical companies: get a little more medication, reduce the cost.
I feel that patients struggle so much. We can help them negotiate, but it's still the finances. That's the biggest struggle.
Barbara Sperrazza, MS, RD,
CD/N, CDE
Diabetes educator
Shands at
AGH
Gainesville, Fla.
Literacy can be a major problem, getting people to understand the treatment plan and the importance of compliance. We have a very high rate of illiteracy. One of the things we can do is try to get family members involved who are more educable.
Carla Herrington, RN, BSN,
CDE Diabetes educator
Colquitt Regional
Medical
Center
Moultrie, Ga.
One of the biggest problems is just how hard it is to get people to change behavior. They have an uphill battle against what everybody else is doing—trying to eat right, to exercise. Just making time to make it happen. With busy lifestyles, it's hard to make those changes. Everybody knows what they need to do, and they want to do it, but just making it happen is not easy.
We can make solutions as easy and workable as possible, and help people understand that even making small steps is going in the right direction. Get them on the track, and hopefully people will keep going in that direction.
Laura Hall, RN, CDE
Diabetes educator
Clark Memorial
Hospital
Jeffersonville, Idaho
My biggest challenge is the delay in consults for me to see people. I typically am not notified of patients who need education until they are going home that day or the next day. I am unable to give them the education they need prior to being discharged from the hospital, because our length of stay is typically 2–3 days. The biggest challenge is having adequate time to teach patients the life-sustaining essentials prior to their going home.
I'm working with staff at the hospital to educate them to be proactive. When they see a patient who is a known to be diabetic, or when a patient is coming back with high blood glucose, they notify me so I can at least screen them to see if it's a teachable moment to start basic education.
Monica Hall, RN, BSN
Diabetes educator
Carle Hospital
Urbana,
Ill.
| TALK BACK: RECREATIONAL VIAGRA When sildenafil (Viagra, Pfizer) was introduced in 1998, it was hailed as a breakthrough for older men suffering from erectile dysfunction (ED)—a common symptom of diabetes and consequence of therapy for hypertension and other conditions. A number of reports suggest that use of sildenafil—and similar ED drugs such as vardenafil (Levitra, Bayer/GlaxoSmithKline) and tadalafil (Cialis, Lilly)—are becoming increasingly popular among healthier young men to enhance performance. According to Express Scripts, a pharmacy benefit management firm with 50 million covered lives, the fastest-growing segment seeking reimbursement for sildenafil is men between 18 and 55 years of age. Pfizer's own data show that the number of men under age 45 using sildenafil tripled in the 4 years following the drug's launch. Some experts contend that it is improper and potentially dangerous to prescribe a drug without a compelling medical need. Others argue that it's better to provide patients with legitimate pharmaceuticals than let them buy fakes or counterfeits over the web. What do you think? Is it ethical and appropriate to prescribe ED drugs for primarily recreational reasons? Should insurance plans pay for it? Send your thoughts to docnews{at}diabetes.org.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
