Sanjay Kalra ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
S Abbas Raza ( Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. )
Diabetes is a pandemic which is becoming endemic to society. Primary care physicians should be able to offer basic diabetes prevention and care services, to ensure timely detection and management of the condition. This expert opinion shares suggestions to help primary care physicians introduce and integrate diabetes care in their routine practice. It identifies and focuses on four pillars: improving oneself, strengthening the health care team, empowering the person living with diabetes, and sensitizing the public at large.
Keywords: Diabetes, glucose control, patient empowerment, person centred care, primary care
Primary care physicians cater to every strata of society, and are expected to handle every medical, surgical and obstetric condition. This is especially true in South Asia, where primary care physicians are accustomed to dealing with a wide variety of acute ailments. The changing profile of disease patterns, however, poses a challenge to experienced primary care physicians. Integrating diabetes care, and metabolic medicine, into primary health set ups can pose multiple academic and logistic hurdles. Senior experts suggest how primary care physicians improve the quality of their diabetes and metabolic services (Box).
Invest time in continuing medical education (CME). Find CME content from respected organizations, such as the Pakistan Endocrine Society,1 South Asian Federation of Endocrine Societies, and International Diabetes Federation.2 CME programmes can be digital in nature, or can be accessed through journals such as the Journal of Pakistan Medical Association (JPMA).3
Familiarize one with drugs listed in Essential Medicines List.4 Once comfortable with using them, prescription can be expanded to include newer drugs and drug classes. Equip the pharmacy with the drugs that you plan to prescribe. Limiting oneself to one or two drugs, from each class, and one to two trade names of each preparation, helps ease logistic concerns. Good quality manufacturers should be preferred to ensure efficacy, safety and tolerability.
Strengthen the Team
Begin educating the health care team, such as physician assistants and nurses, about the basics of diabetes and metabolic care. Try to explain complex concepts in vernacular language, using local idioms, proverbs and analogies. This creates a team of para medical staff who can contribute to diabetes education. The International Diabetes Federation has a curriculum for diabetes education: begin by teaching the staff primary aspects of care, followed by secondary and tertiary topics.
Explore and use every resource possible.5 Explore the possibility of including a dietician, physiotherapist, psychologist and pharmacist in the health care team. There may be colleges in the vicinity who would welcome the opportunity to give practical exposure to their students. Internship arrangements may be made to create a win-win situation for all.
Strengthen the Person Living with Diabetes
The success of diabetes care depends upon the self-management skills and actions of the person living with diabetes.6 Incorporate patient education and patient empowerment in each and every clinic encounter. The more the awareness and involvement, the greater are the chances of an individual seeking diabetes care, and adhering to therapy.7 The concepts of therapeutic patient education (education is a therapy in itself) and shared decision making (involving the patient in planning management targets and techniques) must be practiced.
Strengthen the Public
Diabetes is not just an individual's disease: its impact can be felt by the family, community and country. Primary care exists to serve the family, community and country. Hence, advocacy and public awareness are an important component of primary diabetes care. Utilize every possible opportunity to advocate for effective diabetes care good glucose health. Interact with religious leaders to spread the message of good diabetes care and its importance.8
Well begun is half done. It is our responsibility, as primary care providers, to offer effective diabetes care to our patients. The guidance contained in this communication should stimulate us to begin fulfilling our duty, to our society.
1. Pakistan Endocrine Society. Available at: https://www.pakendosociety.org/general-public-area/. Last accessed on 22 April 2021
2. Professional education. Available at: https://idf.org/our-activities/education.html Last accessed on 22 April 2021
3. Kalra S, Punyani H, Dhawan M. Creating happiness in the diabetes care clinic. J Pak Med Assoc. 2020;70:1099-1100
4. WHO Model Lists of Essential Medicines. Available at: https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/essential-medicines-lists. Last accessed on 22 April 2021
5. Higa C, Davidson EJ, Loos JR. Integrating family and friend support, information technology, and diabetes education in community-centric diabetes self-management.J Am Med Inform Assoc.2021;28:261-75.
6. Kalra S, Gupta Y. Self-management of diabetes in primary care. J Pak Med Assoc. 2015;65:686-7.
7. Kalra S, Unnikrishnan AG, Skovlund SE. Patient empowerment in endocrinology. Indian J Endocrinol Metab. 2012;16:1-3.
8. Mahtab H, Pathan MF, Ahmed T, Bajaj S, Sahay R, Raza SA, et al. The Dhaka Declaration 2015. Indian J Endocrinol Metab. 2015;19:441-442.