Background: Diabetes is a chronic disease that has turned into a global healthcare epidemic. With time, the focus in diabetes care has shifted to patient education and empowerment. Diabetes educators are professionals who focus on educating individuals with and at risk for diabetes to become effective self-managers. Diabetes educators do not only provide information and education regarding diet, exercise, and a healthy lifestyle but also help manage other aspects of diabetes as well as prevention of secondary complications of diabetes.
Methods: Our community health clinic is a resident-run clinic. Patients can follow with a diabetic educator in the same building by making a separate appointment. We conducted a retrospective chart review from January 2017 to March 2019 to see how many patients with type 2 diabetes were referred to diabetes educators. We also measured the difference in HbA1C among patients who did and did not follow up with diabetes educators. Patients with a history of ESRD and who were on steroids were excluded.
Results: A total of 190 patient charts were reviewed out of which 75 met the inclusion criteria. Only 32 of the 75 patients included had followed up with the diabetes educator. There were 11 patients in the non-following arm who were referred but had not been seen. We calculated the change in HbA1C measured immediately before and then 6 months to 1 year after following up with Diabetes educator in patients who did and did not follow with the diabetes educator. The average HbA1c of patients before following with diabetic educators was 9.63% and at the 1-year interval, it came down to 8.25%. The average change seen in HbA1C was -1.38 among patients who followed up with diabetes educators as compared to +0.17 in the patients who did not.An interesting trend noticed was that PCPs tend to refer patients with higher A1Cs for diabetes educators with the average A1C for the referred population being 10.47%.
Conclusions: In this retrospective review, we observed that patients who followed with diabetes educators had an average 1.51 points improvement in their HbA1C at follow-up as compared to patients who did not. Improvement in HbA1C reflects better diabetes control which in turn helps prevent secondary complications. This difference can be attributed to focused diabetes management visits with a diabetic educator as compared to the primary care physician where the PCP has to address multiple comorbidities leaving limited time dedicated to diabetes-specific education.It is important to highlight that we need to utilize these professionals not only for patients with uncontrolled diabetes but more importantly so for prediabetes and newly diagnosed DM so we can help educate these individuals and hopefully prevent complications of diabetes. There is also a need to encourage participation by patients in education so we can help them become self-sufficient in the knowledge of their disease as well as its management. The availability of diabetes educators with same-day visits as PCPs in community clinics may help overcome the issue of patients having to go to multiple visits.