Effectively Educating Your Newly Diagnosed Patient with Diabetes

For newly diagnosed patients with type 1 or type 2 diabetes, education about diabetes is critical and should start immediately. For the clinician, the major tasks are to provide key information in the context of a “partnership” approach to treatment without overwhelming the patient. Broadly, education can be divided into three main components: essential backgrounder information about diabetes; the major principles that drive the diabetes treatment program, with an emphasis on diet and exercise; and specific information about clinically proven treatment options.

Type 1 diabetes is an autoimmune disease in which the body does not produce enough insulin due to pancreatic ß-cell destruction, while type 2 diabetes is primarily characterized by a mismatch between insulin production and demand, insulin resistance, and decreasing pancreatic function. Home glucose monitors allow patients to measure their blood glucose levels independently and consistently, while clinicians measure patients’ glycohemoglobin levels every 6 to 12 weeks to assess their average blood sugar levels over time.

The driving treatment principle in patients with type 2 diabetes is starting with diet and exercise, as well as an oral agent, and eventually adding on additional therapies. Eventually, the majority of patients will need insulin. This is attributable to the natural history of the disease and not to “failure” on the part of the patient or the overall treatment regimen. There are numerous clinically proven treatment options for diabetes. Data from the Diabetes Prevention Program (DPP) showed the diet and exercise decreased the risk of newonset diabetes in atrisk patients by 58% and that metformin decreased risk by 31%. The UKPDS showed that metformin significantly reduced the rate of all-cause mortality in patients with diabetes who had not been previously treated with metformin. Two other prevention trials, TRIPOD and PIPOD, which evaluated the use of troglitazone and pioglitazone, respectively, in women with prior gestational diabetes established a role for the thiazolidenediones as important first-line treatment agents. Data from these trials indicated that these agents were beta-cell sparing in the study subjects, an important finding.

When treating patients with diabetes, achieving euglycemia is the goal, and ongoing modification of the treatment regimen is the rule,not the exception. With this in mind, educating patients on their disease, including the importance of the decisions they make about diet, exercise, and overall adherence to their treatment regimen is a critical part of overall disease management.

In this conversation, two diabetes experts, Dr. Brian Tullock and Dr. Naveed Igbal, join Dr. Carlos Hamilton to discuss issues related to educating newly diagnosed patients with diabetes.

Related References/Reading:

1. Xiang AH, Peters RK, Kjos SL, et al. Effect of pioglitazone on pancreatic beta-cell function and diabetes risk in Hispanic women with prior gestational diabetes.
   Diabetes. 2006;55:517-22.
2. Johnson JA, Majumdar SR, Simpson SH, Toth EL. Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes.
   Diabetes Care. 2002;25:2244-2248.