Patient's Perspectives

: Perceived Benefits and Barriers to the Diabetes Prevention Program; Objective: Diabetes prevention interventions have a proven positive affect on health outcomes. The goal of this project is to understand the factors that motivate and deter people with prediabetes from utilizing evidence-based education programs, such as the Diabetes Prevention Program (DPP).Research Design and Methods: Formative research was conducted among program managers, health providers who care for diabetics, and patients living with prediabetes to generate an in-depth understanding of perceptions of the program. The methodology included a mixed methods approach. A total of 97 interviews and 5 focus groups were conducted with health providers, program managers and patients. An online survey was administered to 50 patients with pre-diabetes.Results: All three populations agreed the DPP aided in implementing lifestyle changes and preventing the onset of type 2 diabetes and the classes provided a positive experience for support, in-depth discussion, and opportunities for learning how to make lifestyle changes. However, while the overall benefits of the program were expressed, there were barriers noted by all populations that affect program utilization and physician referrals. General lack of knowledge, cost of the program, and the significant time commitment necessary to complete the program were barriers discussed.Conclusions: The Diabetes Prevention Program is successful in helping individuals with pre-diabetes make positive lifestyle changes. However, lack of knowledge about the program is a deterrent for utilization. Creation of a social marketing campaign designed based on the findings from this research will aim to increase health care providers referrals to the DPP., diabetes, prediabetes, management, education, programs

: Building a Bright Future for Diabetes Care and Management by Writing Where It Hurts; Getting insight into the illness experiences of people with highly prevalent chronic conditions like diabetes is positively critical for all of us in the health world, whether were more on the clinical care side or more on the research side or experiencing things from the patient or family perspective. To illuminate these complex interplays between clinical and community elements of living well with diabetes and other chronic conditions, we need narratives and critical analysis of all aspects of illness experience.To promote sharing of these narratives both from people with diabetes and from a diverse array of others living with chronic physical and mental health conditions as well as experiences within and between marginalized communities we started the Write Where It Hurts project. WWIH is a narrative-based blog and social media outreach hub focused on disclosure and critical analysis of experiences in health and the social world that are challenging and/or traumatic in nature., narratives, chronic conditions, illness, marginalized, social media, blog

: Difference a CDE Makes; Over the years, my endocrinologist and my CDE have both helped me with my diabetes management, but in different ways. My endocrinologist helped me maintain my physical health. Meanwhile, my CDE helped me with the mental aspects such as diabetes math, searching for patterns, and even discussing burnout.Diabetes gives me plenty of reasons to get sad or mad or frustrated. I definitely do not need to go in search of those things. But diabetes has also given me a connection to some wonderful people I would have never met without it. I consider my CDE and endocrinologist to be two of those people. This life with diabetes has given me an opportunity to become my own best advocate, and I am so thankful for the health insurance that I have that allows me to have a wonderful health care team behind me., diabetes, management, burnout

: Fakebetes Challenge; Objective: Healthcare providers do not typically fully understand what it is like to live with a chronic condition. One strategy to help healthcare providers better understand the day-to-day challenges of living with diabetes is to practice being a patient. The purpose of this study was to understand the experiences of healthcare providers and patient educators who participated in the Fakebetes Challenge, a high-fidelity simulation of living with diabetes that utilized patients who were living with diabetes as teachers.Research Design and Methods: In this descriptive qualitative pilot study, blogs written by participants following their participation in the Fakebetes challenge were examined using content analysis.Results: The Fakebetes Challenge was beneficial to both healthcare provider learners and patient experts who served as educators. Three themes were identified: 1) enjoyment from the teaching-learning process of having Fakebetes; 2) healthcare providers ability to relate, understand, and empathize; and 3) Fakebetes challenge concerns and frustrations expressed by Fakebetes Teaching Associates.Conclusion: The Fakebetes Challenge as a pedagogical approach is promising in educating healthcare providers about the day-to-day challenges of living with diabetes and should be replicated with a larger sample. Patients with personal experience and expertise in diabetes can supplement healthcare provider education and support patient-centered care., diabetes, management, education, programs

: Narrative Inquiry in Diabetes Research; Diabetes self-care is integrally and holistically connected with everyday life, but research prior to 2008 primarily used surveys and interviews to understand the psychosocial aspects of the illness experience. Narrative research methods, in contrast, can give greater attention to connection and context. The aim of this paper is:1) to review empirical studies using narrative methods to understand the insights narrative inquiry can offer into diabetes psychosocial experiences and concerns; and2) to provide methodological recommendations for researchers interested in using narrative inquiry.Twelve published empirical articles using narrative inquiry in diabetes research were reviewed, and themes were identified using content analysis. Findings from the analysis of these 12 studies suggested narrative inquiry can offer insight into psychosocial experiences and concerns by:1) illuminating how those with diabetes think about and make meaning of this chronic disease;2) articulating the social contexts of their experiences; and3) making visible the self-care and treatment challenges they face.Insights from narrative inquiry could enhance diabetes self-management education and support such as encouraging patients to express their experiences as stories to make their challenges visible., diabetes, narrative inquiry, management, education

: Patient's Perspective; e-Patient Dave deBronkart, cancer survivor and patient advocate, discusses the changing nature of the patient-physician relationship, with the patient becoming an active contributor and partner in their care. Engaged and empowered patients, e-patients, can help raise levels of consciousness about complex health problems. They can help clinicians and researchers understand living with these problems better, and realize what can be done to solve them., diabetes, patient physician relationship, management

: Paying More at the Pump; The decisions for how we live well with diabetes, and what therapies and technologies we need to do that, should be made between the person with diabetes and their trusted health care professionals. Insurance should be a partner in achieving these goals, not a barrier. In order to do that, we must give preferential treatment to the patient at the center of business and health care, hold those entities accountable who get it wrong, and reward those who get it right., diabetes, insurance, health care

: Preoperative Glycemic Control for Adult Diabetic Patients Undergoing Elective Surgery; As the prevalence of diabetes continues to increase in the United States, a higher proportion of elective surgical candidates will require specific preoperative education and guidelines to maximize patient outcomes and reduce the costs of care. The purpose of this article is to review the current literature to determine how preoperative glycemic control affects the lengths of hospital stays, postoperative complications, and mortality in people living with type 1 and 2 diabetes. Additional recommendations are provided for preoperative hypo- and hyperglycemia, the use of insulin pumps or continuous glucose monitors, and day-of-surgery management of insulin and oral hypoglycemic agents. Gaps in medical evidence are acknowledged and future directions in research are proposed to provide high-quality guidelines for the preoperative care of adult patients with diabetes., diabetes, preoperative, management, glycemic control, guidelines

: Real Cost of Diabetes Education; Whether we are patients, clinicians, or researchers, its easy to agree that more education about the best practices and strategies of managing diabetes of all types is preferable to ignoring actions that can lead to positive results. Now more than ever, research and reputable sources are confirming that diabetes education is beneficial to long term success with all types of diabetes.If this education is so important, then we shouldn't be forced to pay more for that CDE visit than what it costs to see an endocrinogist. Seeing an educator can be just as important, if not more, than many other parts of a person's D-management and that can lead to healthier lives, fewer complications, and even less cost for insurers and the overall health system., diabetes, management

: Redefining Difficult; I frequently refer to myself as the difficult child not so much in my family setting, because there I am clearly the perfect daughter (just ask my sister!). But professionally, I am sometimes difficult because I have been known to ask a lot of questions, and to think outside of the square. I am a risk taker.But many physicians would consider me to be a difficult patient, a term that I really struggle to understand. When I ask questions or walk into a healthcare providers office asking to try something new, I am not being difficult or questioning their expertise. Quite the opposite. I am there to solicit their expertise, to have a discussion about how I can improve my health, and couple what I know about my life with diabetes with their knowledge of medicine to try to crack the combination that leads to success, longevity, and less fear of eventualities and unknowns. For healthcare providers, I understand how these questions are absolutely time consuming, schedule bending, and exhausting. But the relationship that they have with their patients is as necessary as the relationship that I have with my diabetes, and the questions are required for both to prosper., diabetes, management

: Transitioning from Pediatric to Adult Diabetes Care; Objective: The clinical transition from pediatric to adult diabetes care is often challenging for both young adults with type 1 diabetes (T1D) and the health care providers (HCPs) who care for this population. This study presents insights into the perceptions and needs of both patients with diabetes and HCPs during the clinical transition.Research Design and Methods: Two separate surveys were administered with questions specifically tailored to each audience. Perceptions of the transition phase for both patients with T1D and HCPs were analyzed for general trends and then compared to investigate similarities and differences between patient and provider needs.Results: Both patients and HCPs expressed concerns regarding poor patient-provider communication during transition and the barriers to independently managing diabetes self-care responsibilities (e.g. navigating insurance, ordering supplies, arranging healthcare appointments). Although 45% of HCPs reported screening transition age patients for mental health issues related to diabetes, only 9% of patients stated their provider offered this opportunity. Furthermore, patients reported facing a variety of challenges not discussed with their HCP including: sexual issues (28%), depression or anxiety (17%), and eating disorders (11%).Conclusions: Training in the assessment of young adult T1D needs and effective communication techniques may assist HCPs in working more effectively with young adults. Offering mental health screenings for transition age patients may open the conversation to discuss diabetes concerns such as depression, sexual challenges, and eating disorders not currently being addressed. Both patients and providers desire improved communication with more emphasis on independently managing diabetes responsibilities and adjusting to new life situations., diabetes, pediatrics, young adults, adolescents, management

: Will the Affordable Care Act Deliver?; Marshall Kapp, JD, MPH, is an authority when it comes to the intersection of medicine and law. Presently he is the Director of the Florida State University Center for Innovative Collaboration in Medicine and Law, where the PLAID team had the opportunity to chat with him about how the Affordable Care Act (ACA) is impacting people living with diabetes., diabetes, affordable care act

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