Optimal Management of Diabetes: Expert Nurse Practitioner Perspectives - Episode 8
Davida Kruger, MSN, APN-BC, BC-ADM: We’re in the middle of a pandemic.
Lucia Novak, MSN, ANP-BC, BC-ADM, CDTC: I was just going to mention that.
Davida Kruger, MSN, APN-BC, BC-ADM: What’s interesting to me—as we’ve all gone through the same thing—is that in March, we were terrified because we didn’t know how we were going to continue to deliver care. Here we are almost at Christmas, and the reality is that, in the diabetes world, we have done a heck of a job in being able to transfer that care to remote care, including starting people on injections, continuous glucose monitoring [CGM], or whatever it is. Have you seen any slowdown in your own world of being able to teach a patient how to remotely take a GLP1 receptor agonist injection?
Lucia Novak, MSN, ANP-BC, BC-ADM, CDTC: Not at all. It does help if they can get the prescription in hand. In that way, we do it together, or my MA [medical assistant] will do it together with them by video. We’ve been doing this within not just injectable medications but pumps and CGM as well. You name it, we’ve figured it out. Davida, when you mentioned all the things that you mentioned about why primary care providers should be using the GLP1 receptor agonists, and then you throw in COVID-19 [coronavirus disease 2019], we have an even greater reason to put our patients on a GLP1 receptor agonist because of the impact on keeping those blood sugars stable, which we know improves outcomes or reduces the risk of a severe infection or severe outcome in our patients, as well as the weight loss that’s also associated with poor outcomes with COVID-19. Even the pandemic can be used as a reason why we need to do this.
Davida Kruger, MSN, APN-BC, BC-ADM: I agree, and it is an easier therapy. I agree 100%. Let’s talk briefly about any comments of yours on unmet needs, future directions in the treatment of patients with diabetes, and anything you can think of that we haven’t said.
Lucia Novak, MSN, ANP-BC, BC-ADM, CDTC: One of the biggest unmet needs is getting our patients into diabetes education. I can’t stress that enough: It’s a medication, not a therapy. It’s not even something that clinicians have to do themselves. They just need to send a patient to a certified diabetes care and education specialist and allow that patient to be surrounded by another aspect of their village to help them with diabetes management, and they can be surrounded by others who are going through the same thing. To me, that’s even bigger than the medications because we still don’t have enough of our patients getting into those classes. That’s still an unmet need.
Davida Kruger, MSN, APN-BC, BC-ADM: I know you mean this within diabetes education, but there is also medical nutritional therapy and dietitians.
Lucia Novak, MSN, ANP-BC, BC-ADM, CDTC: Yes.
Davida Kruger, MSN, APN-BC, BC-ADM: I don’t know if you included that, but I just wanted to say that as well because I don’t know where anybody learns about what happens with how to manage food. Think about your own education.
Lucia Novak, MSN, ANP-BC, BC-ADM, CDTC: Right.
Davida Kruger, MSN, APN-BC, BC-ADM: Medical nutritional therapy, diabetes education, websites—all of those are things that really do help bolster the patients’ understanding. I always tell my patient that they have to own their own diabetes and be their own best advocate in this whole career of diabetes because they know themselves, and they need to be able to say, “This is what I can do and what I need,” so we can help our patients.
This has been wonderful talking with you. It’s been great fun, and it’s been illuminating on so many avenues of the topic of type 2 diabetes and certainly for the use of GLP1 receptor agonists.
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Transcript Edited for Clarity