Diabetes Management Model

Diabetes management represents a complex approach that challenges the patient, the provider, and the current healthcare system. Various weaknesses for the diabetes management are unveiled by research articles in the lack of care coordination among the multi-specialty team groups managing diabetes , lack of patient education and self-care management and the need for implementation of standardize guidelines in primary care practice for patients with diabetes. Moreover, decreased numbers of primary physicians and increased the role and responsibilities for NPs in the current healthcare structures reveal the need of better strategic approaches for delivering care for the patients with type 2 diabetes. The results from the academic literature

The rationale for implementing the CHCC in the clinical practice delineates the need for a holistic approach following the ADA evidence-based guidelines on managing the patients population with type 2 diabetes. CHCC differs from other models by increasing education about diabetes management and prevention as well as reducing redundancy of information and time restrains (Barud, Marcy, Armor, Chonlahan, & Beach, 2006). The CHCC model promotes a structured group visit in which the patients are prescheduled for the visit. These visits incorporate a number of approximate 10-15 group members lead by an interdisciplinary team of professionals. According to ADA (2016) guidelines the team involved in these sessions are physicians, NPs, diabetes educators, clinical pharmacists, nutritionist, medical assistance, psychologist and social workers. The leading role in these group meetings is owned by the physicians, NPs, pharmacist, nutritionist and certified diabetes educator. The role of the multidisciplinary effort is to educate the patients about the diabetes pathophysiologic process, prevention of further complications tackling topics like diabetes education, nutrition, smoking cessation, physical activity, routine immunizations, and psychosocial care. This comprehensive care approach suggests that

Therefore, the length of the sessions would be best delineated by 90 minutes frame time with 10-15 minutes individual one –on- one visit with the healthcare provider and 45 minutes reserved for the group discussion. Before any session the physician or NP should evaluate the Hgb A1c quarterly and fasting lipid profile include LDL, HDL, cholesterol and triglyceride, liver function tests, urinary to creatinine ration, serum creatinine, estimated glomerular filtration rates, thyroid stimulating hormones in patient with dyslipidemia or in women aged >50 years annually( ADA, 2016). During the individual visits, the patient should have vital signs, pneumococcal and influenza vaccination, laboratory tests and diabetes maintenance related care performed by the registered nurses in accordance with the ADA guidelines. It is imperative to emphasis that the clinical pharmacist, physician or an NP should oversee and monitor the medication therapy and related problems, refilling the medications and glucometer supplies. Another component of the one- on- one visits would be delineated by the primary provider (physician or NP) to perform physical assessment including the foot assessment and education per ADA recommendations (ADA, 2016) The group visits that follows the individual sessions should be conducted by a physician, NP, certified diabetes educator (CDE) or