Your PCP Is an Important Part of Your Diabetes Care Team

We hear time and again about the importance of patients establishing and keeping a relationship with their primary care provider (PCP) for health maintenance and disease management. Ongoing communication between the PCP and the patient is vital to helping the patient achieve his or her health goals.

What about with diabetes? People may think that this condition, which affects nearly 1 out of every 10 Americans, requires a medical specialist. However, at UPMC, patients benefit from the close partnership between their PCP and their specialists, including endocrinologists, and even diabetic nurse educators which is improving the care our diabetic patients receive.

Managing Diabetes with Your PCP

Your PCP is the touch point for your ongoing wellness – from annual visits and physicals to providing vaccines, caring for acute illness or injury, and other visits not limited to chronic follow-up of care, which is important in following and managing your diabetic testing through Hba1c and microalbumin urine measurements. But your PCP also works in tandem with a multidisciplinary team of providers, including endocrinologists, diabetes educators, dietitians, etc., in order to ensure the best overall care and to help you achieve your short- and long-term health goals.

Managing a condition like diabetes involves looking at dietary intake, activity level, current therapy and other behaviors and types of care. PCPs and endocrinologists work together with you to evaluate any progress or setbacks, and watch for any other services, treatment, or management that may be warranted later. UPMC in Central Pa. offers diabetes inpatient and outpatient programs along with support groups designed to work with your treatment plan.

Diabetes affects many parts of the body requiring a range of expertise. Diabetics are at increased risk of developing vision loss, kidney failure, vascular complications (including amputations), and premature death, in addition to heart disease and cerebrovascular disease (stroke). Diabetes risk increases with weight gain, and managing weight, diet, activity, and stress are important by working with your provider to ensure these measures are being addressed and followed.

What type of diabetes test does your PCP use?

Treating your diabetes involves more than just looking at blood glucose levels. At regular check-ups, your PCP should be looking for any changes with:

• Height or weight
• Neurological reflexes or sensations of numbness or tingling of the extremities
• Foot examinations
• Circulation
• Wounds
• Recent illnesses
• Eye exams or dental visits (including asking when was the last time these were done)
• Testing such as Hba1c, and blood glucose monitoring at home
• How often blood glucose is checked at home, and how diet may be affecting any changes
• Treatment compliance
• Microalbumin urine testing

UPMC in Central Pa.’s Team Approach Makes a Difference in Diabetes Treatment

UPMC in Central Pa. is known nationally for its successful inpatient and outpatient diabetes programs. Our inpatient program is certified by the Joint Commission as a Center for Excellence, a distinguished recognition that makes UPMC a premiere leader in diabetic treatment and the first in Pennsylvania to receive that recognition.

Through our multidisciplinary approach to diabetes care, we are able to:

• Provide diabetes and nutrition education support at primary care office sites.
• Bring in diabetic educators and diabetic-specific nurse practitioners to focus on complex cases at our most populated sites.
• Engage a nurse with experience in population health management to support patients’ needs and goals.
• Empower medical assistants to provide initial education and “download” meters in their respective office sites.
• Develop a patient registry of individuals with Hba1c levels greater than 9 percent and secure monthly data reports for each practice site (to distribute and discuss among providers and even communicate with endocrinologists).
• Encourage providers to discuss select cases with the endocrinologist via email and in person.
• Offer providers additional training and educational programs on diabetes management.
• Share a pocket booklet with ADA guidelines for blood glucose control with all providers.

By closing the gaps in fragmented care, this partnership allowed UPMC in Central Pa. to reach our original goal of decreasing Hba1c levels from 25 percent to 20 percent in our patients.

What is diabetes?

Diabetes is a condition where your body cannot use food energy stores properly. There are more than 30 million Americans with diabetes in our country alone, and according to the ADA (American Diabetes Association) there are an additional 1.5 million Americans diagnosed with diabetes annually.

Diabetes symptoms can include thirst, blurred vision, weight changes, and increased urination. And it is usually diagnosed through a fasting plasma glucose blood test done or a glycosylated hemoglobin (Hba1c). It should be noted, though, that of the 30+ million Americans who have diabetes, one-quarter are undiagnosed.

Types of Diabetes

There are several types of diabetes. Type 2 diabetes mellitus is a chronic condition that affects the way the body processes blood glucose, but doesn’t require taking insulin. More than 90 percent of diabetes patients are Type 2.

Type 1 diabetes involves an issue with the pancreas having the inability to maintain or produce insulin, leading to insulin deficiency and requiring insulin. This type affects 5-10 percent of the population.

There are other types of diabetes, including Gestational Diabetes. This occurs during pregnancy when a woman’s pancreas cannot function well enough in order to overcome the insulin resistance that the placenta may encompass along with the increased energy demands from the mother for both her and her fetus. This affects approximately 2 percent of the population.

Other types of diabetes may be due to diseases affecting the pancreas (i.e., pancreatitis, trauma, or cystic fibrosis), hormone disorders of the pancreas (i.e. Cushing’s syndrome or pancreatic cancer), or drug-induced diabetic conditions.

It is worthy to note that nearly 84 million people in our country are “pre-diabetic,” which increases their risk of type 2 diabetes, yet 90 percent do not know they have it, according to the American Diabetes Association.

Learn more about diabetes care.