Diabetes calls for a team effort. Different healthcare providers frequently tackle the disease together, often with amazing results. According to a report in Clinician Reviews, teamwork has been shown to shorten the length of hospital stays and can help keep patients from coming back to the hospital. Patients who work with a healthcare team are also less likely than patients who see only one doctor to suffer long-term complications such as blindness, kidney disease or damage, nerve damage, heart failure, and stroke.
These benefits don't have to come at a steep price. In fact, the group approach can actually save patients money. A study in the Journal of Clinical Endocrinology and Metabolism found that teamwork helped cut the price of a typical patient's medical care by about $50 per month.
Before you can get the most out of your team, you have to know the players. The roster may change slightly from year to year to reflect your needs, but the core group will probably remain intact. Here's a look at some of the professionals who could make up your diabetes team.
Every healthcare team needs a leader. In this case, that's you. You're the one who has the most control over your diabetes, the one who really calls the shots. It's your job to keep your team updated, but you're the one who has to lobby for the right care and be vigilant about getting the right tests. If you've got the right team assembled, then at least you won't have to do it alone.
As the American Diabetes Association puts it, "You are the most important member of your health care team...And of course, you are the first to notice any problems.Your health care team depends on you to talk to them honestly and to tell them how you feel."
Primary care doctor
Primary care physicians are on the frontlines of diabetes care. They play a central role in diabetes management: Few of them can get through the day without seeing at least one patient with diabetes. Although they may not have training in the complicated facets of diabetes, they are usually very experienced in the main aspects of managing this very common disease. Primary care doctors are usually the ones to make the diagnosis of diabetes, prescribe lifestyle changes and medications when needed, and perform tests that can help determine whether a patient is reaching his treatment goals. Just as importantly, primary care doctors are usually responsible for assembling the right team to take care of each individual patient. They can make referrals to other healthcare specialists when needed to manage or prevent complications of the disease. If you think something is missing from your care, talk to your primary care physician about it. He or she may be able to address those questions directly or through a referral to a team member.
A nurse educator or diabetes nurse practitioner is a registered nurse (RN) who has special training and expertise in caring for and teaching people with diabetes; some have a masters degree. Nurse educators can help you learn how to take care of your diabetes, such as when and how to your medicines.
An endocrinologist has specialized training in diseases that involve hormone imbalances, including diabetes. A primary care doctor is likely to refer you to an endocrinologist if your blood sugar isn't responding to standard treatment. Endocrinologists are often involved when complicated treatment plans involving multiple drugs are under consideration, or when a patient needs special technologies such as an insulin pump to keep his blood sugar under control.
Certified diabetes educator
Certified diabetes educators give patients practical tips for living with the disease. Diabetes educators can be nurses, registered dietitians, social workers, exercise physiologists, as well as pharmacists and physicians. They provide important guidance on diet, exercise, blood sugar monitoring, and medication. Ideally, a patient should see one of these professionals soon after the diagnosis. Many hospitals have classes for newly diagnosed patients that cover all aspects of the disease, from using a glucose monitor to choosing what to eat at a restaurant.
This kind of diabetes education can be a critical part of managing your disease and insuring that you succeed. In fact, studies show that people who get diabetes education are better at managing their blood sugar levels and have fewer diabetes-related complications, according to a report presented at the American Diabetes Association's annual conference.
Diabetes and diet are so closely intertwined that every patient should work with a registered dietitian, and the sooner the better. As soon as you're diagnosed, a dietitian can help you put together meal plans to meet your specific needs. Even if you've already seen a dietitian, your primary care doctor may recommend a refresher course if you develop diet-related problems such as high cholesterol or obesity.
Eye doctor (Ophthalmologist)
Early treatment can help prevent blindness, one of the most feared complications of diabetes. For this reason, the American Diabetes Association urges every patient to see an ophthalmologist at least once per year for a comprehensive eye exam.
Patients should also see an eye specialist immediately if they develop any eye pain, inflammation of the eye, or changes in your vision, such as constant blurs and spots.
Foot care is a crucial -- but often overlooked -- part of living with diabetes. Your primary care physician can probably treat minor problems such as corns, but more serious problems call for more specialized care. If you have a problem with calluses or thickened nails, your primary care doctor may refer you to a podiatrist, a healthcare professional who specializes in foot care.
Since people with diabetes are at greater risk for gum disease, be sure to see your dentist every six months (and make sure she or he knows you have diabetes).
Even more than doctors, pharmacists know all about medicines. It's important to find one pharmacy that you like and keep using it. Your pharmacist can track your history, tell you about possible drug interactions with your medicines and side effects to watch out for.
Exercise can help you lose weight, lower your blood sugar, use insulin more efficiently, and feel better. An exercise physiologist can help you develop an exercise plan, but be sure to have it approved by your doctor.
Social worker, therapist, psychiatrist or counselor
Living with diabetes may take an emotional toll on you or your family, so you may need outside help dealing with it. Talk with your doctor about a referral.
Depending on how well you're managing your disease, you may not need more than your primary care doctor to help you control your diabetes. But most people require some form of specialty care along the way, whether it is simply for education or to treat complications of the disease. If the disease is more advanced, you may be referred to specialists in addition to those listed above. You may see a nephrologist who specializes in kidney diseases, for example; a neurologist who can treat nerve damage in your feet; or, for men, a urologist who treats sexual dysfunction. If you're feeling depressed or frustrated about managing diabetes, you may consider seeing a counselor or finding a support group led by a certified diabetes educator to help you cope.
American Diabetes Association. Your Health Care Team. 2017. http://www.diabetes.org/living-with-diabetes/treatment-and-care/whos-on-your-health-care-team/your-health-care-team.html.
A fresh approach to diabetes management: make it a team effort. Clinician Reviews. Vol. 12(2): 49-53.
Rubin, RJ et al. Clinical and economic impact of implementing a comprehensive diabetes management program in managed care. Journal of Clinical Endocrinology and Metabolism. Vol. 83: 2635-2642.
Joslin Diabetes Center. Guidelines for specialty consultation/referral.
American Diabetes Association. Standards of Medical Care in Diabetes. http://care.diabetesjournals.org/content/vol28/suppl_1/
Jones, H, RN, MSN, et al. Changes in Diabetes Self-Care Behaviors Make a Difference in Glycemic Control. Diabetes Care, Vol. 26: 732-737.