Nursing News November 4, 2021

By Debra Wood, RN, contributor

Nurses and Diabetes Care: 10 New Keys to Prevention and Management

A diabetes epidemic has swept the country as the population ages and becomes more overweight and obese, but nurses play an important role in educating patients about prevention and management of the chronic condition.

“Nurses are in a unique position to make a big impact on the diabetes epidemic,” said Kristine Batty, PhD, APRN-BC, BC-ADM, CDCES, spokesperson for the Association of Diabetes Care & Education Specialists (ADCES). “Nurses can identify those at risk of developing diabetes and those in need of assistance in managing diabetes. Nurses provide education on healthy lifestyle choices and provide resources for access to health care and medications.”

Approximately 34.2 million people in the United States have diabetes, more than 10 percent of the population, according to the National Institute of Diabetes and Digestive and Kidney Diseases. About 26.9 percent have been diagnosed and 7.3 are unaware of their condition.

Another 88 million adults, 34.5 percent of U.S. adults have prediabetes, with higher blood glucose levels than normal but not enough for a diabetes diagnosis.

Batty recommended nurses refer people with prediabetes to the National Diabetes Prevention Program, sponsored by the Centers for Disease Control and Prevention (CDC) or to a diabetes care and education specialist.

“Nurses need to know that every interaction they have with a person at risk for diabetes or who has diabetes is an opportunity to improve that person’s health,” Batty said. “Whether you provide education or assist with access to medications or healthcare, nurses can make a difference.”

What’s new in diabetes care

“In 2021 there is more known about how to prevent and treat diabetes than ever before, including the best treatment options and technology,” Batty said.

1. COVID-19 concerns

Forty percent of all COVID-19 deaths were in people with diabetes, according to Robert Gabbay, MD, PhD, FACP, chief scientific and medical officer for the American Diabetes Association. He recommended all persons with diabetes get a COVID-19 vaccine. 

“It has never been more important to have well managed blood glucose in order to reduce adverse effects of an infection such as COVID-19,” Batty said.

Access to insulin has been problematic due to changes in employment and income during the pandemic, Batty added.

“Nurses need to be aware of the current risk status of the pandemic and other health-related challenges in the United States, continuing to educate on the prevention of COVID-19 based on CDC recommendations and why these recommendations are important for those with diabetes,” Batty said.

2. Inpatient CGM

Nurses at The Ohio State University Wexner Medical Center in Columbus came up with an idea to use continuous glucose monitors (CGM) for medical ICU patients with COVID-19 to reduce the need for nurses to enter the patients’ rooms. The device’s transmitter sent the glucose reading to a receiver outside of the room. The IV pump also was kept outside the room. The hospital eventually expanded the CGM to all COVID-19 patients. The U.S. Food and Drug Administration approved the inpatient use of CGMs for patients with COVD-19.

“It saved the nurses exposure of going into the room,” said Laureen Jones, MSN, clinical nurse specialist for the MICU at the medical center.

They are now conducting an implementation study about using CGM and its potential to change care and nursing burden.

3. Community outreach programs

Providers are reaching out into the community, rather than expecting patients to always come to the clinic for diabetes care, reported Edwin Torres, PhD(c), RN, CHNP, FNP-C, a nurse practitioner at Montefiore Health System. The health system takes a team approach to educate patients about diet, exercise and disease management. Nurses and diabetes education are key to better outcomes. 

At Spectrum Health in Grand Rapids, Michigan, programs for patients with prediabetes and those with diabetes include nurses and diabetes education, including lifestyle changes and culturally relevant information, said Phallon LoveLady, DNP, RN-BC, manager of Community Health Programs, Healthier Communities for Spectrum Health.

4. Importance of sleep

“Sleep has a direct effect on glucose regulation,” said Stephanie Griggs, PhD, RN, assistant professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, who researches sleep and diabetes. In a small study, she found sleep variability had the strongest correlation with CGM readings and less time in range. 

“We have extensive evidence, that [sleep health] needs to be a priority,” Griggs said.

5. Software and apps

“There is a plethora of new software and apps developed and put on the market targeting diabetes prevention and management,” Batty said. “Some of this technology focuses on blood glucose tracking, food tracking, weight loss and physical activity. ADCES is a strong advocate for technology in the treatment of prediabetes and diabetes.”

6. Holistic focus

While still concerned about glucose levels, clinicians also are taking a more holistic approach and trying to prevent cardiovascular, renal and other complications of diabetes, Torres said.

“I don’t want to see a patient who has a stroke in the ER; I would like the patient to prevent the stroke,” Torres explained.

7. Awareness of social determinants of health

Transportation, housing, availability of healthy foods, a safe place to exercise and other social determinants now are being taken into consideration for preventing diabetes. 

“Removing barriers or understanding their impact can help healthcare providers, including nurses, and systems better understand how to prevent and also manage diabetes,” LoveLady said.

8. Islet cell transplants

“In April 2021, the FDA approved islet cell transplant for those with ‘brittle’ Type 1 diabetes who have been unable to stabilize glucose through traditional and advanced treatment modalities,” Batty said. “While the number of people with diabetes that qualify for islet cell transplant is small, this a big step in the right direction.” 

9. Advancements in insulin pumps

“Insulin pump therapy continues to improve the algorithms for insulin delivery to keep blood glucose in range and is getting closer to an entirely closed loop system,” Batty said. “Smart insulin pens are the newest technology on the market. These pens work through a software app that calculates and tracks insulin doses.”

10. More medications available

Torres reported having 14 different classifications of medications to choose from to better manage diabetes. New agents include dulaglutide (Trulicity) and semaglutide (Ozmpic), and nurses can provide education about them. 

As diabetes care continues to evolve, nurses remain on the front lines of helping people live with the disease.

“People can have an awesome, quality life while appropriately managing diabetes,” LoveLady said.

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