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Keeping Current With Diabetes in Your Practice
Guest Editorial
Keeping Current With Diabetes in Your Practice Donna Marvicsin, PhD, PNP-BC, CDE, and Barbara Freeland, DNP, ACNS-BC, CDE
T
oday, the prevalence of type 2 diabetes in all populations is growing. Regardless of the practice setting, nurse practitioners (NPs) are likely to encounter people with type 2 diabetes. The American Diabetes Association (ADA) recognizes that in the United States diabetes can become a lifelong label that has associated moral stigma. Individuals diagnosed with diabetes are often sensitive to the unstated judgment of others. “Perhaps if you exercised more, ate less.” “If only you had not become overweight . . .” Therefore, the ADA position is that diabetes does not define people, and the word diabetic is no longer used when referring to individuals with diabetes. Diabetes is a complex chronic condition requiring continuous medical care beyond managing glycemic control. Living well with diabetes is a lifelong journey that touches every aspect of an individual’s life. It is hard work, and the relationship between a nurse practitioner and patient can be crucial to preventing complications. Nurse practitioners often manage other chronic conditions and comorbidities including hypertension, hyperlipidemia, and complications of diabetes. The current treatment paradigm can feel like treat to failure. We advise patients to “try diet and exercise” until the A1C drifts up and then add oral agents and again wait until the A1C drifts up further before finally adding insulin. This model of practice can lead to frustration for both the patient and the provider, triggering clinical inertia and blaming. The patient may become less
A24
The Journal for Nurse Practitioners - JNP
adherent to treatment recommendations, and the nurse practitioner may be slow in responding to changes in diabetes status, delaying needed advances in treatment. Being aware of potential biases will allow NPs to maintain their energy in patient engagement and mutual goal setting while guiding patients to optimal outcomes. This special edition of Journal for Nurse Practitioners highlights topics we believe would be useful to NPs in practice and include clinical standards of care that are continually updated based on new research and new products. In January of each year, the ADA publishes new standards of care that reflect the latest in research findings and expert consensus. In addition, resources to promote patient knowledge, engagement, communication, and educational tools can be found at the American Association of Nurse Practitioners website. Links to external organizations with additional resources are available at https:// www.aanp.org/education/education-toolkits/diabetes. Both authors are affiliated with the School of Nursing at the University of Michigan in Ann Arbor. Donna Marvicsin, PhD, PNP-BC, CDE, is a clinical associate professor. Barbara Freeland, DNP, ACNS-BC, CDE, is a clinical assistant professor and can be reached at [email protected]. 1555-4155/17/$ see front matter © 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.12.024
Volume 13, Issue 3, March 2017
Keeping Current With Diabetes in Your Practice Donna Marvicsin, PhD, PNP-BC, CDE, and Barbara Freeland, DNP, ACNS-BC, CDE
T
oday, the prevalence of type 2 diabetes in all populations is growing. Regardless of the practice setting, nurse practitioners (NPs) are likely to encounter people with type 2 diabetes. The American Diabetes Association (ADA) recognizes that in the United States diabetes can become a lifelong label that has associated moral stigma. Individuals diagnosed with diabetes are often sensitive to the unstated judgment of others. “Perhaps if you exercised more, ate less.” “If only you had not become overweight . . .” Therefore, the ADA position is that diabetes does not define people, and the word diabetic is no longer used when referring to individuals with diabetes. Diabetes is a complex chronic condition requiring continuous medical care beyond managing glycemic control. Living well with diabetes is a lifelong journey that touches every aspect of an individual’s life. It is hard work, and the relationship between a nurse practitioner and patient can be crucial to preventing complications. Nurse practitioners often manage other chronic conditions and comorbidities including hypertension, hyperlipidemia, and complications of diabetes. The current treatment paradigm can feel like treat to failure. We advise patients to “try diet and exercise” until the A1C drifts up and then add oral agents and again wait until the A1C drifts up further before finally adding insulin. This model of practice can lead to frustration for both the patient and the provider, triggering clinical inertia and blaming. The patient may become less
A24
The Journal for Nurse Practitioners - JNP
adherent to treatment recommendations, and the nurse practitioner may be slow in responding to changes in diabetes status, delaying needed advances in treatment. Being aware of potential biases will allow NPs to maintain their energy in patient engagement and mutual goal setting while guiding patients to optimal outcomes. This special edition of Journal for Nurse Practitioners highlights topics we believe would be useful to NPs in practice and include clinical standards of care that are continually updated based on new research and new products. In January of each year, the ADA publishes new standards of care that reflect the latest in research findings and expert consensus. In addition, resources to promote patient knowledge, engagement, communication, and educational tools can be found at the American Association of Nurse Practitioners website. Links to external organizations with additional resources are available at https:// www.aanp.org/education/education-toolkits/diabetes. Both authors are affiliated with the School of Nursing at the University of Michigan in Ann Arbor. Donna Marvicsin, PhD, PNP-BC, CDE, is a clinical associate professor. Barbara Freeland, DNP, ACNS-BC, CDE, is a clinical assistant professor and can be reached at [email protected]. 1555-4155/17/$ see front matter © 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.12.024
Volume 13, Issue 3, March 2017