HAPPY NEW YEAR!!!!

Now that we are in a new year, its time for an updated Standards of Care. Every year, the American Diabetes Association publishes the year’s Standards of Care. It comes with recommendation and the areas that providers should apply to their care of patients with diabetes. This, as with any new updates or guidelines from other governing bodies, is something that as nurse practitioners we should review and implement regularly.

I thought it would be a good idea to give an overview of sorts for my nurse practitioner colleagues. Now let me give this DISCLAIMER…you as a nurse practitioner that manages diabetes, should read the complete document for yourself. I will link it >HERE< for you to view. The purpose of this is to pull out what I found interesting and the topics I believed were notable. I am not reviewing the whole document line by line in this blog post but simply discussing some of the main ideas in the 2021 Diabetes Standards of Medical Care specifically FACILITATING BEHAVIOR CHANGE with patients with diabetes and those at risk for diabetes. Again, let me mention that for this particular post, I am focusing on section 5 of the Standards of Care. I’ve read through the complete Standard and wanted to highlight this section. I strongly urge you to read the complete article (please refer to the links above).

2021 Diabetes Standards of Medical Care | Facilitating Behavior Change

One of the statements in the introduction of this section is one of the reasons why I wanted to discuss this section in particular.

“Effective behavior management and psychological well-being are foundational to achieving goals for people with diabetes.”

As providers, it is very easy for us to focus in on the medical side of diabetes and swiftly rush to the treatment of diabetes. This is important yes but diabetes is a dynamic disease and therefore requires a dynamic approach. In section five of the article, five areas were highlighted:

• Diabetes Self-Management Education & Support

• Medical Nutrition Therapy

• Routine Physical Activity

• Smoking Cessation Counseling

• Psychosocial Issues

In the following sections, let’s unpack this a bit…

Diabetes Self-Management Education & Support (DSMES)

With DSMES, the patient with diabetes is increasing their knowledge of the diagnosis and their decision making skills. As a nurse practitioner, our role is to help them stretch the muscle of self-management. The reality is that our patients spend more time away from us than in our clinics so it is NECESSARY for them to competent in managing the diagnosis.

I have more to say about this in later posts but I’ve spoken on this already on Instagram (@thediabetesnp). I do an IG Live Series called TUESDAY TIPS and I touched on this in one of the recent sessions >HERE<. In a nutshell, our care should be PATIENT-CENTERED & FOCUSED to increase patient outcomes.

Medical Nutrition Therapy (MNT)

I have touched on this as well on my platforms. Back in the summer, I created a whole month’s worth of posts over nutrition for patients with diabetes. Check that out >HERE<. MNT’s goal is to promote healthy eating habits while reaching glycemic, BP, & lipid goals. Partnering with a Dietician would be beneficial here! As providers, we always want to consider culture in everything that we do and also educate our patients that eating can still be pleasurable even when eating healthy.

Routine Physical Activity

The recommendations for physical activity were pretty much the same but I do want to point out a few things here:

1. With the rise of childhood obesity, we are seeing more kids with Type 2 Diabetes. The recommendation for children with Type 1 and Type 2 diabetes is 60min/day of moderate to vigorous exercise.

2. Adults should get 150min/week of moderate to vigorous exercise (75min/wk for younger and more physically fit individuals) with no more than 2 days in between sessions.

3. Resistance training 2-3x/week

4. Flexibility training and balance training 2-3x/week for older adults.

Also, if you are interested, I made a patient education video over the self-care behavior, BEING ACTIVE. Share with your patients as needed.

Smoking Cessation Counseling

Nothing new here…counsel your patients when needed. Cigarette and e-cigarettes is not recommended for any of our patients.

Psychosocial Issues

Address psychosocial needs should be apart of all diabetes care. Assessing the patients attitudes toward the diagnosis, fears and beliefs will better help you as the provider meet those needs. Also, don’t forget our vulnerable groups like the elderly and teens/young adults. Though all patients should have their psychosocial needs assessed and addressed, these two populations are at high risk for experiencing anxiety or depression related to the diagnosis of diabetes. Here’s a patient education video over HEALTHY COPING.

That’s all I got folks! Of course, I have a video that I discuss this in detail. Check it out below and while you are there, please SUBSCRIBE. I put out weekly videos with the nurse practitioner in mind! Also below are some resources that may be helpful to you as well!