Creating an interdisciplinary diabetes management team: a quick guide to type 2 diabetes self-management education.
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This week, I had a difficult situation when my patient came in for a follow-up visit about his diabetes management. Patient S.M. was a 52-year-old Armenian male who had recently moved to the country and presented to the clinic complaining about his type II diabetes mellitus. Patient S.M. had never seen a doctor or an endocrinologist in his home country and had no idea he had diabetes until he was hospitalized a few months ago in the United States. S.M. has been unable to control his blood glucose levels since learning of his diabetes diagnosis. The patient’s most recent hemoglobin A1C level was 8%, indicating that he was not adhering to his diabetes management and diet plan. When speaking with this patient, I learned that he consumes at least 4-5 cans of soda per day and is not adhering to the diabetic diet regimen that the nurse practitioner had taught him the last time he visited the clinic. I handled this situation by pausing momentarily to consider the bigger picture. As a future nurse practitioner, I aim to improve my patients’ overall health outcomes. Diabetes mellitus, for example, can be a chronic condition, and patients may struggle to accept the reality of it. They should be reminded that this is a chronic condition and that self-care is required. It is frequently tricky because patients, for example, do not always follow the recommended path, as with diabetes noncompliance. According to a National Library of Medicine article, clinical diabetes management and teaching diabetes self-management skills are required for optimal type 2 diabetes control (Chester et al., 2019). Following a thorough evaluation and ongoing education, We referred this patient to a dietician or a diabetes education facility for additional diabetes management education. The 2017 Standards of Medical Care in Diabetes Care in Diabetes, as stated by Chester et al., recommend that each person with diabetes be actively engaged in education, self-management, and treatment planning with his or her healthcare team, including the collaborative development of an individualized eating plan (Chester et al., 2019). Surprisingly, I reached this patient after providing appropriate diet education and self-glucose monitoring. I also told him we wanted to see a significant decrease in his Hgb A1C levels in three months, and he seemed to agree.
Reference
B. Chester, G. W. Stanley, & T. Geetha (2019). Creating an interdisciplinary diabetes management team: a quick guide to type 2 diabetes self-management education. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199222/
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This week’s compelling case was a 10-year-old female pediatric patient who was accompanied to the clinic by her mother due to a recent motor vehicle accident in which she was a passenger. The mother described the incident as a head-on collision with a bus near the Grand Canyon caused by black ice. At the hospital, about 10 to 20 centimeters of the ileum were surgically removed, along with a duodenum rupture repaired. The patient also had a brace on her L4 vertebrae, a seatbelt injury on her bilateral hips, and three teeth lost due to the car accident.
I used evidence to support my actions by considering how the ileum affects vitamin B12, bile acids, iron, passive water absorption, cholesterol, and several immune-protective functions (Bisgin et al., 2022). As a result, vitamin B12 and iron levels will be drawn as part of the patient’s treatment plan once the patient feels better. The neurosurgeons in the hospital placed a brace for the spinal fracture; additionally, a follow-up with the neurosurgery team is scheduled within one to two weeks to reassess stability or continued need for the brace (Healthwise, 2022). A referral to the dentist was made for repair and future tooth loss plans. Finally, post-traumatic stress disorder is expected because the patient was involved in a traumatic incident (Mental Health America of Eastern Missouri, 2021). A child with post-traumatic stress disorder may relive the incident through nightmares or persistent thoughts (Mental Health America of Eastern Missouri, 2021). As a result, referral to a psychologist for behavioral therapy, psychotherapy, and further psychological diagnostic evaluation was advised (Mental Health America of Eastern Missouri, 2021).
References
T. Bisgin, S. Sokmen, B. Manoglu, S. Ozkardesler, S. Sarioglu, and H. Ellidokuz (2022).
Ileal resection was overlooked as a prognostic factor in patients with peritoneal metastasis. Scientific Reports, 12, doi:10.1038/s41598-022-16100-x
Healthwise. (2022). (2022). Care instructions for children with a spine compression fracture.
https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=ug5400&
Eastern Missouri Mental Health America (2021). Anxiety disorders in children.
https://www.mha-em.org/im-looking-for/mental-health-knowledge-base/demographic-children-teens/9-anxiety-disorders-and-kids
You appear to have dealt with two complex cases this week, both with care and evidence-based practice. In the case of a diabetic patient, it is critical to address the patient’s noncompliance with education and treatment recommendations and includes a diabetes educator or dietician in the care plan. Self-management is critical for controlling diabetes and preventing complications, as you mentioned. In the case of the pediatric patient, it is critical to address not only the physical injuries but also the possibility of post-traumatic stress disorder (PTSD) resulting from a traumatic event such as a car accident. The patient’s care plan should include a referral to a psychologist for further evaluation and therapy. Overall, it is clear that you approach patient care with care and consideration.