Provider Influence on Diabetes Self-Management

Troy Trygstad, PharmD, MBA, PhD; Dhiren Patel, PharmD; Steven Peskin, MD, MBA; and Richard Wynn, MD, explore the value of patient education at the pharmacy and provider levels in promoting good self-management skills in diabetes.

Troy Trygstad, PharmD, MBA, PhD: What is the role of self-management skills? What is the role of the teach-back method, C1D1 Teach 1, group visits, or the Stanford model? How does that care delivery process change for you, in your practice environment, where you are more cognizant of the need for the patient to be a member of the care team? How have you changed your practice with that realization?

Dhiren Patel, PharmD: Nutrition was one component, and you manage self-management skills. If you look at some of the trials that we’ve had within the Diabetes Prevention trials and whatnot, you look at behavior change. I think that is going to be your next blockbuster drug. If we were prescribing that in the same way that we could prescribe all of these other medications, it would completely be a game changer.

Steven Peskin, MD, MBA: Behavioral Rx.

Dhiren Patel, PharmD: But again, it’s easy for me to sit here and say that rather than actually do it, make sure that it gets executed. A lot of those self-management skills are within each of these components on that care plan. A lot of it is behavior change.

Troy Trygstad, PharmD, MBA, PhD: I think my next letter from the editor, in Pharmacy Times^®, is going to be on behavior changes and the next blockbuster drug. I’ll make sure you’re coauthor.

Steven Peskin, MD, MBA: What Dhiren said, I loved it. I would also say that part of that self-management is self-insight. You have to, again, understand what a blood sugar of 40 versus 400 means. If you really don’t understand the concept, your blood sugar gets really low. We totally take it for granted. I’m guilty as charged. And when your blood sugar gets really low, your thinking gets cloudy. You could have a terrible accident. You could wreck your car and hurt somebody. I know you don’t want to hurt somebody. And then, if your blood sugar’s really, really high, again, you can kind of go to sleep and be really confused. So, it’s important that people understand what these numbers mean and that they understand what the consequences are. It gets very ethereal, a lot of times.

Troy Trygstad, PharmD, MBA, PhD: Self-management skills. What have you implemented in your practice to sort of promote this? Who else do you work with—either inside a practice, on the care team, or outside of the practice—to either prescribe behavior change or to encourage or work with others to get that? You can only deal with the patient in your office when they’re in your office. How is it that you’re translating that out when they’re living, working, and playing out there?

Richard Wynn, MD: My most successful intervention was probably diabetic classes. I did my board certification in bariatrics, and it completely transformed my diabetic care. I started doing groups for patients that were out of control together with providers in the practice. My intention was to go through a 5-week series of lectures. But what happened is, they kept coming. They didn’t drop out after 4 weeks or 5 weeks. They kept coming. We had to add more classes. But they bonded with each other. There was this reinforcing of correct information, or what I think of as the correct information, versus what their hairdresser told them. Someone’s saying, “Well, I tried that and this is what happened.” They wonder how she’s doing. “She was having trouble with that.” They wanted to see what’s happened when they see them again. So, that cohort AA meeting, or support group, really made a huge difference for them. And, actually, a couple of peer counselors who now work for one of the major hospital systems came out of those classes. There were patients who went on to become peer educators to work with other diabetics.

Troy Trygstad, PharmD, MBA, PhD: So, really what we’re all talking about here is the human condition and how the human condition relates to a disease state. I have a good friend who once asked me, “What would happen to the entire industry, the health care system, if we invented a drug that cured every disease?” My response to him was, “We’d figure out a way to screw it up.”