Nudging Patients to Ward Off Diabetes – Health Blog – WSJ

By Laura Landro

David Sulwer
Renee Henson, left, a diabetes nurse educator, shows Celeste Roundtree the best location for pricking her finger for blood glucose monitoring. At right is Dr. Adrienne Evans, the physician who diagnosed Ms. Roundtree with prediabetes.

With as many as 1 in 3 U.S. adults having prediabetes, as WSJ’s Informed Patient column reports, health-care providers are ramping up education and management programs to help people make the lifestyle changes — such as weight loss and exercise — needed to ward off full-blown Type 2 diabetes.

The National Diabetes Prevention Program led by the Centers for Disease Control and Prevention,  offers group lifestyle-change classes based on the Diabetes Prevention Program research trial which showed that people with pre-diabetes could reduce their risk of developing Type 2 by 58% by losing 5% to 7% percent of their body weight and getting 150 minutes of exercise each week.

The program is offered in a number of states, with many of the enrollment costs covered by health plans.  The recently introduced Medicare Diabetes Prevention Act, endorsed by groups including the American Diabetes Association would provide coverage of the program under Medicare.

Health care providers are increasingly offering their own programs at outpatient clinics and community centers.

Winston-Salem, N.C.-based Novant Health for example, has found that about 10% of patients admitted to its hospitals for other reasons have undiagnosed diabetes, and many others seen by its doctors in more than 380 medical practices have pre-diabetes. Novant offers diabetes prevention and management courses at a number of locations — and its diabetes educators are often the ones who have to break the news to patients and get them into a program.

Angela Mauck, a nurse who works as a diabetes educator at Novant’s Thomasville Medical Center, tells the Health Blog that the first time she visits a patient’s room to discuss test results that indicate they have diabetes, “the reaction is usually shock and surprise.”

Information about the diagnosis is sent to the patient’s regular physician, who can then make a referral for an education program. Diabetes educators can determine if patients need one-on-one education or a group class.

Ms. Mauck says she’s been impressed by how determined patients can be about improving their health, “and when you see the personal changes in these folks it is amazing.”

But sometimes patients don’t follow up, which requires diabetes educators to be persistent.

Renee Henson, a nurse and diabetes educator at Novant’s Presbyterian Hospital in Charlotte,  was going through the files of patients who hadn’t followed up on referrals and found Celeste Roundtree, who was diagnosed last year with pre-diabetes by Novant-affiliated physician Adrienne Evans. Ms. Roundtree, 51, admits she was in denial, but Ms. Henson was persistent, finding a class convenient to her home that she is now attending on a regular basis.

Typically, the classes help patients understand the basics such as diet, nutrition and exercise and blood sugar monitoring; after three months patients are evaluated to see if their blood sugar is in better control. The program costs about $900, and though it is often covered by insurance, costs can be a barrier for some.

“We are currently trying to come up with different ways to get diabetes education out to the public, even if we have to volunteer,” Ms. Henson says.

Diabetes Awareness


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