AANP Member Spotlight: Supporting Patients at the Intersection of Diabetes and Cardiovascular Disease
Hear from Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, FAANP, Region 11 Director for the American Association of Nurse Practitioners® (AANP), on her experience as a diabetes expert panelist for Know Diabetes by Heart™.
According to the American Heart Association® (AHA), cardiovascular disease (CVD) remains the leading cause of death in the United States, and it’s a major cause of heart attack, stroke and heart failure each year. While there are a number of risk factors associated with CVD, people who have Type 2 diabetes mellitus (T2DM) in particular are at increased risk. Patients with T2DM may often face hypertension, unhealthy cholesterol levels, obesity, poorly controlled blood sugar and a lack of exercise — all conditions that contribute to a greater risk of developing CVD.
To raise awareness of the link between T2DM and CVD, and to support health care providers in educating patients, AHA has joined forces with the American Diabetes Association® (ADA) to present Know Diabetes by Heart. This initiative is designed to address the combined national health impact of T2DM and CVD by providing tools and resources for both patients and providers.
One such resource is the educational Living With Diabetes: Ask the Experts Q&A series. Each event in the Q&A series covers a different subject, ranging from medication management and numbers to watch to healthy food options and physical activity. Participating in each event are diabetes experts, such as AANP Fellow and Regional Director Dr. Cassarino, who answer questions from people living with T2DM across the country.
Dr. Cassarino joined the panel for the July 14 event: Make the Most of Your Health Care Visits, which offered tips on how patients should prepare to meet with their diabetes care team. “It was extremely interesting to hear questions from people across the country,” says Dr. Cassarino. “In general, people are very alike in their needs and concerns when it comes to discussing their diabetes care.”
Effective, Informative Visits to Ease Patient’s Fears
At the July 14 event, Dr. Cassarino spent about one hour on the telephone helping to answer questions from people with T2DM and giving practical tips on how they could prepare for a visit to their health care providers. She notes that patients are often afraid to review their lab test results, have concerns about adding new medications to their regiment and may not want to hear that their diabetes is not well controlled.
“Patients may also have a fear of injections or needles, so when we start injectables, we spend a lot of time showing patients how small the needle is. Staff will do an injection with the patient in the office for the first time to ease their worries,” Dr. Cassarino says.
“The standard of care is to use whatever interventions necessary to get a patient to goal, but new medications may mean increased costs, potential drug interactions and side effects. Patient education is extremely important.”
To that effect, she stresses that health care providers can help patients be more prepared before each visit. For example, when a patient does not know every medication they are currently taking, staff must spend time gathering this information and updating the medication list instead of addressing the patient’s other concerns.
“It’s helpful to give patients small ‘homework assignments,’ such as bringing their blood sugar log or list of medications to every appointment, so everyone on their diabetes care team is fully informed,” says Dr. Cassarino. “When patients are unprepared, they may also forget what questions they have to ask. We want to make their appointment time as efficient and effective as possible.”
The COVID-19 pandemic has also led to a change in the delivery of diabetes care from in-office visits to a telehealth model. Now, not only must health care providers understand the technology and best practices, but they must also assist patients in transitioning to a virtual model of health care.
“Telehealth is very different from an in-person visit. Both the provider and patient have to have the right technology, but they also have to be comfortable using it. It’s also important patients have a private, quiet area from which to meet with their provider,” explains Dr. Cassarino. “Sometimes we can suggest that a family member help a patient navigate the telehealth model, and we collaborate to improve a patient’s comfortability for future visits.”
Diabetes Resources for Nurse Practitioners (NPs)
“It’s important for all health care providers, including NPs, to stay educated and up to date on new therapies to help your patients with diabetes reach their goals,” says Dr. Cassarino, who shares that ADA has released its Standards of Medical Care in Diabetes — 2020 and often releases interim updates as needed throughout the year.
In addition, the Make the Most of Your Health Care Visits event was archived, so you can encourage patients to listen to the full recording or short clips on specific topics. This event also presents three free patient handouts for use in your practice:
- 4 Questions to Ask Your Health Care Provider About Diabetes and Your Heart.
- Getting the Most Out of Health Care Visits.
“There are also continuing education [CE] courses on endocrinology at the AANP CE Center. Most have pharmacology hours, and it’s a free resource for AANP members,” adds Dr. Cassarino.
AANP’s Endocrinology Specialty Practice Group (SPG) allows members who are interested in endocrinology and diabetes to interactively collaborate with colleagues. By joining this SPG, NPs have access to a cutting-edge, online forum for discussions, document sharing and knowledge exchange. Plus, there are many more tools available on AANP’s Endocrinology Therapeutic Areas webpage, from patient handouts to helpful practice resources on continuous glucose monitoring (CGM)!