Improving diabetes management in a primary care setting
Type 2 diabetes is one of the country's most common chronic diseases affecting one in every 10 Americans.1 We sat down with our Chief Medical Officer, Dr. Paul Mikulecky, to get answers to questions regarding diabetes and its management.
Is diabetes becoming more common?
According to the Centers for Disease Control and Prevention (CDC) , the number of people with diabetes is higher than ever, and people are developing the illness at younger ages.
What are the leading causes of diabetes?
Genetics, lifestyle choices, and other Social Drivers of Health (SDoH) can contribute to a person developing diabetes.
Genetics
We can't put all the blame on our genes, but having a family history of diabetes can increase the chances of developing it. Some ethnic groups, such as African Americans, Latinos, and Asian Americans, are more likely to have the disease.
Environmental and social factors
The American Diabetes Association says you can inherit a predisposition to the disease, but something in your environment has to trigger it. People with lower socioeconomic status are more likely to develop diabetes. In the United States, of the adults diagnosed with diabetes, 15% were living below the poverty line, 19% were experiencing food insecurity, and 50% had low diet quality.2
Lifestyle
Being overweight puts you at risk of developing diabetes. An inactive lifestyle, smoking, drinking, and not getting enough sleep can also increase the risk.3 That’s why doctors recommend a well-balanced diet and regular exercise as a complement to type 2 diabetes treatment.
How do primary care doctors work with diabetic patients?
With diabetes, primary care doctors work to understand the patient and the driving influences. Ultimately, we're looking at diet, exercise, and what we can manage from a medical perspective.
The patient's diet may be influenced by cultural or behavioral factors — as in the case of stress eating. It may also be affected by income and access to healthy food options. Additionally, patients may not be familiar with nutritional concepts, such as how food is processed in the body.
As a starting point, we encourage patients to eat better and exercise regularly to control their diabetes with fewer medications.
What are some features of the diabetes management program at Carelon Health?
At Carelon Health, our diabetes management program takes a holistic approach and provides a multidisciplinary team to treat the whole person. Our nurse practitioners and doctors are diabetes specialists and are responsible for medical management while relying on the expertise of others. For example:
- A behavioral health expert can address depression, anxiety, or impulsive behaviors that influence eating.
- A social worker can connect the patient with resources to help pay for medications or healthy foods.
- A pharmacist can help with medications and provide education regarding good nutrition and meal planning.
We assess the patient to establish their current state and what contributed to it, and we work with them to understand the condition. Knowing how their choices affect their blood sugar levels will help them best control their diabetes.
What are your thoughts on remote patient monitoring and diabetes technology like continuous glucose monitors (CGMs)?
They are powerful tools when used appropriately. People who use a CGM have fewer instances of hypoglycemia and a lower A1C level .4
We're also exploring the use of wearables to transmit blood sugar readings and engage with patients virtually. As patients log their blood sugars on a device, we can capture that information and make recommendations. It would allow us to stay on top of real-time situations rather than after the fact.
Are there conditions related to diabetes we need to watch for?
Type 2 diabetes correlates with increased weight and body mass index (BMI), high blood pressure, and elevated cholesterol. If the patient crosses a certain weight or BMI threshold, the risk of heart attacks, strokes, and other complications increases.
For some patients, even losing 5% to 10% of their total body weight can produce health benefits, such as improvements in blood pressure, cholesterol, and blood sugar.5
About Dr. Paul Mikulecky
Dr. Paul Mikulecky is Chief Medical Officer for Carelon Health. Read Dr. Mikulecky's bio to learn more about his role, experience, and education.
1 Centers for Disease Control and Prevention: The Facts, Stats, and Impacts of Diabetes (accessed May 2023): cdc.gov.
2 American Diabetes Association: Studies Uncover Stark Impact Social Determinants of Health Have on Youth and Adult Populations with Diabetes (accessed May 2023): diabetes.org.
3 American Heart Association: Diabetes Risk Factors (accessed May 2023): heart.org.
4 American Diabetes Association: Continuous Glucose Monitors — Why are CGMs Beneficial? (accessed May 2023): diabetes.org.
5 Centers for Disease Control and Prevention: Losing Weight (accessed May 2023): cdc.gov.
