Language makes a difference. Clinicians once talked about “diabetes cases.” Then it became “diabetes patients,” “patients with diabetes” and “patient-centered care.” The focus in 2022 is “person-centered care.” People living with diabetes, their families, and caregivers notice the difference.
“The movement from patient-centered to person-centered means a different spectrum of focus, attention, and care,” said Kellie M. Rodriguez, RN, MSN, MBA, CDCES, Director of Global Diabetes and Infectious Diseases at Parkland Hospital, Dallas. “Patient-centered has always had a focus on the clinical nature of diabetes. The person-centered focus is a huge opportunity because it means we look beyond the clinical spectrum to the whole person in their lived world. Social determinants of health are a huge driving force in the achievement of outcomes that are significantly more impactful than the clinical impact we can have.”
Rodriguez will open a symposium exploring Creative Strategies for Person-Centered Care and Education—Addressing Diversity, Equity and Inclusion at 2:15 p.m. CT Sunday, June 5, in La Nouvelle Orleans Ballroom B at the convention center.
When it comes to managing diabetes, the world that an individual lives in every day is the single most important piece of the puzzle, Rodriguez said.
“When I see labile blood glucose levels, my first question is, ‘Tell me about your life. What makes you smile?” she said. “It’s very often those answers that explain the glucose profile and are the source of my diabetes-related strategies and solutions. When it comes to managing chronic disease, we need to expand our focus from the clinical nature of the visit to what happens or doesn’t happen between visits. People are living 99% of their lives outside the health care system and outside of our clinics.”
Clinical care matters, but only if it’s care that a patient is willing and able to accept, and has the resources to implement. Prescribing an unaffordable, evidence-based medication for someone earning minimum wage without health coverage may not help them manage their diabetes.
“Person-centered care is working with the person with diabetes to figure out the best medications that fit their life versus saying, ‘This is the guideline and the evidence and the best drug,’” said Katherine S. O’Neal, PharmD, MBA, BCACP, CDCES, BC-ADM, CLS, FADCES, Associate Professor of Pharmacy at the University of Oklahoma Health Sciences Center College of Pharmacy. “Evidence and guidelines don’t always work for individuals, especially if there are financial or social barriers. It’s all about the person, their understanding of the disease, [and] their understanding of how they can help themselves with our assistance.”
Advice on diet, exercise, and other lifestyle factors must be equally personalized. Telling diabetes patients what they should and should not eat can be counterproductive. A more useful approach can be to talk about their current diet, the foods that are important to their family, and then work from there.
“The changes people make to better manage their diabetes have to fit the culture they live in,” explained dietitian Lorena Drago, MS, RDN, CDN, CDCES, owner of Hispanic Foodways LLC. “I focus on Hispanic and Latino health—people who may have been told that rice is bad for diabetes, or tortillas are bad. If the foods they grew up with [and] that are the center of their lives and their families’ lives are bad, managing diabetes becomes problematic. It’s not that certain foods are bad, but that other foods are better and some are best for diabetes. We need to provide individuals with information and education based on what they can do and what is available to them. This symposium is about the practical tips that can help clinicians see where people are in their lives and develop action steps based on what they can actually accomplish.”