When a 92-year-old woman with dementia in my company’s managed long term care (MLTC) plan had to switch from oral diabetes medication to insulin recently, Yael Reich, a nurse diabetes specialist with the Visiting Nurse Service of New York (VNSNY), was the person who arranged for a friend to administer the shots. In her dual role as diabetes educator and complex case manager, Yael advises VNSNY nurses across New York City, Westchester and Nassau on how to help our patients and health plan members with diabetes manage their glucose levels. “Approximately one-third of our patients have diabetes in addition to their primary diagnosis,” says Yael, who’s worked with VNSNY for 23 years and has been a diabetes specialist and educator since 2004. “This means our nurses are treating thousands of patients with diabetes on any given day.”
Type 2 diabetes, in which a person’s blood glucose levels become chronically elevated, can lead to kidney and eye damage, cardiovascular disease and other health problems. In addition to reviewing with our nurses and their patients the proper way to administer diabetes medications that keep blood glucose levels under control, Yael will also explain to them how weight loss, a healthy diet, exercise, and other lifestyle changes can help prevent diabetes in those who are at risk of developing it, and minimize the need for medication in those who already have diabetes.
According to the CDC, more than 29 million Americans are living with diabetes, and 86 million are living with prediabetes, a serious health condition that increases a person’s risk of type 2 diabetes and other chronic diseases. With type 2 diabetes rates in the U.S. continuing to rise—one in eleven Americans now has the disease, according to the most recent estimates, including one out of four people aged 65 or older—understanding how to prevent and control the condition through lifestyle changes and proper medical care is more important than ever. And since people who have diabetes or are at high risk of developing the condition make up a disproportionate share of home care patients and clients, the visiting nurses and nurse educators employed by home care agencies like VNSNY play a lead role in helping to keep this dangerous condition in check.
Bridging the Gap Between Medical Advice and How People Really Live
One important way that frontline home care clinicians make a difference is by helping their patients bridge the gap between advice they receive from medical professionals and taking steps to follow this advice on a daily basis in the real world. For example, when registered nurse Sheniqua Johnson was providing care recently for a patient with elevated blood glucose levels, her patient agreed readily with her advice to avoid foods high in sugar and processed carbohydrates—but then consistently refused to act on her recommendations. “He didn’t want someone coming in from the outside telling him what to do,” Sheniqua says. On speaking with him further during her home visits, she learned that he was originally from West Africa, and with that information in hand, she was able to engage him around healthy foods he’d grown up with and steer him toward a healthier diet.
By visiting with people in their homes, our nurses and nurse educators also come to understand real-life barriers that may not be as obvious to other medical professionals. Fresh vegetables and fruit are often difficult to access in lower income neighborhoods, and can be costly when they are available. As a result, people frequently turn to more convenient and affordable—but less healthy—alternatives. Nurse Johnson recalls caring for a woman who was struggling with diabetes, and noticing that her kitchen shelves were crowded with boxes of sugar-sweetened cereal. “To save money, that’s what I eat for dinner,” the woman told her, explaining that she thought she was following her doctor’s instructions. Johnson was able to help her patient identify easy-to-prepare alternative foods, such as frozen vegetables and lentils, in her local grocery store, that she could buy for the same price to provide better nutrition and help keep blood glucose levels in check.
Our frontline clinicians can also help people who haven’t developed diabetes identify and correct their risk factors, by walking them through diabetes risk assessments such as the one the American Diabetes Association (ADA) offers online—a test which you can take yourself by accessing it here. When an assessment indicates that someone’s risk of developing type 2 diabetes is high, our clinicians will then arrange for them to have their blood glucose levels tested to determine whether they have diabetes or prediabetes (an early warning sign that blood glucose levels aren’t being adequately controlled).
Encouraging Daily Diabetes-Fighting Behavior
Whether someone has diabetes, prediabetes, or is simply at risk of getting the disease, our nurses and diabetes educators regularly encourage them to take evidence-based steps to prevent diabetes from developing, or manage their condition more effectively—including losing weight, engaging in physical activity each day, and eating healthier foods. Many of our home health aides are now also trained as Health Coaches, and are using proven techniques such as “motivational interviewing” to help patients make and maintain important lifestyle changes that help them better manage their diabetes and other chronic medical conditions.
In addition to frontline nurses, diabetes educators and home health aides at home care agencies, community-based clinicians also play a significant role in combating the diabetes epidemic. Primary care physicians now routinely refer patients to diabetes educators for practical advice on how to make changes in their daily diets and safely increase physical activity. This is one more confirmation that when it comes to defeating type 2 diabetes, the solution begins at home.