The Standard of Care for Diabetes

Shared Medical Appointments in Diabetes

Diabetes is a chronic disease which has reached epidemic proportions. It is higher in developed than in developing countries. The number of adults with diabetes in the world will rise from 135 million in 1995 to 300 million in the year 2025 [1]. The management of diabetes mellitus is complex requiring significant self-management skills, support to prevent acute complications and to reduce the risk of long-term complications. Issues beyond glycemic control need to be addressed [2]. Every patient diagnosed with diabetes needs to have his meter/linsulin pump/logbook assessed by the, physician, microvascular screening including eye exam, neuro –monofilament exam, foot exam/pulses, urine albumin, Cr, GFR, assessment of lipid profile, blood pressure, anti-platelet agents needs to be done. In addition the patient needs smoking cessation screening/counseling, immunizations update and malignancy screening. Along with this almost every patient with diabetes to a certain degree needs counseling for healthy eating habits, monitoring of blood glucose, medication compliance that includes both oral and injectable agents and attendance to specialist appointments. Although health education can be disseminated by various methods, individual patient appointments with a primary care physician, a nurse prac¬titioner, and/or a registered dietitian are traditionally the standard of care for diabetes.

Given the magnitude of the diabetes problem and rising health care expenses, strategies to pre¬vent diabetes have become increasingly more important. Previous researches have indicated 3.5 hours a day, were needed to provide appropriate care for chronic diseases like diabetes , provided the disease is in stable con...

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...lines with specific goals for patients with regard to glucose control, blood pressure and total cholesterol(table 1).

First studied in the 1990s, the concept of shared medical appointments holds much promise today in treating patients with diabetes. SMAs are the need of the hour due to shortage of endocrinologists and declining reimbursements. SMAs have several advantages including providing access to the busiest services, especially to newer patients, dramatically decreasing waiting hours for follow-up. SMAs are also excellent for the relatively stable, chronically ill, the “worried well” patients who have extensive psychological needs, more patient contact and professional “hand-holding”.
To address the issues of breach of confidentiality all the group participants are made to sign the "confidentiality waiver and release form" approved by the legal department.