Podcast Summary: Endocrine News Podcast
Episode: ENP93: Prioritizing Patient Experience in Managing Diabetes
Host: Aaron Lohr | Guest: Dr. Rita Kalyani
Date: October 16, 2024
Overview
This episode explores the crucial role of prioritizing patient experience in the management of diabetes. Host Aaron Lohr interviews Dr. Rita Kalyani, professor at Johns Hopkins and President Elect of Medicine and Science at the American Diabetes Association, about a recent Endocrine Society position statement titled Prioritizing Patient Experiences in the Management of Diabetes. The discussion highlights the limitations of traditional guideline-focused care, the need for practical and inclusive strategies, and available tools and approaches to foster patient-centered diabetes management.
Key Discussion Points and Insights
1. The Burden and Complexity of Diabetes
- Global Context: 90-95% of all diabetes is Type 2. Over 500 million people globally, including 38 million in the US, are affected.
- Diverse Experiences: Each individual's experience with diabetes is unique, but common themes—like managing risks, complications, and navigating healthcare—span the life course.
“There are also common themes or common challenges that arise throughout the journey of a lifetime of living with this disease.” – Dr. Kalyani [01:25]
2. Gaps in Care: From Guidelines to Real World Practice
- Guideline Limitations: Clinical guidelines are built on strong evidence, but implementing these in diverse, real-world settings is tough.
- Barriers: Accessibility, cost of new medications, and provider inexperience cause gaps, despite solid evidence for newer agents like SGLT2 inhibitors and GLP1 receptor agonists.
- Implementation Challenges: Dissemination and integration into practice are often missing elements in care improvement efforts.
“That dissemination piece where we really don't have a lot of guidance.” – Dr. Kalyani [03:39]
3. Tools for Patient-Centered Care
Patient-Provider Communication:
- Inclusive Language: Shifting from terms like “diabetic patient” or “glycemic control” to “person with diabetes” and “blood glucose management” to reduce stigma.
- Avoiding Judgmental Terms: Moving away from “compliance/adherence” to describe medication-taking behavior.
- Teach-Back and Motivational Interviewing: Ensuring comprehension and eliciting patient goals/concerns.
“Simple questions can change the whole conversation and eventually help both the patient and the provider achieve the mutual goal of the best health outcomes possible for people with diabetes.” – Dr. Kalyani [23:23]
Screening and Support:
- Psychosocial Assessment: Screening for depression, anxiety, and diabetes distress is vital.
- Education and Team Support: Access to diabetes educators, dietitians, and care teams is important for holistic care.
Practical Tools:
- Teach Back method
- Motivational Interviewing scripts
- Graphic aids (hypoglycemia dashboard, patient journey roadmap)
- Public online directories for finding educators and mental health support
4. Underuse of Available Tools
- Barriers: Time pressures on providers, lack of awareness, and tool usability.
- Solutions:
- Ensuring tools are simple and non-burdensome
- Raising awareness via directories and society resources
- Evolving tools to match technological and therapeutic advances
“The tools can't be burdensome to use in practice because they will just take away otherwise valuable time that the patient and provider have together.” – Dr. Kalyani [08:44]
5. Development and Structure of the Position Statement
- Stakeholders Involved: Multi-society involvement—Endocrine Society, American Diabetes Association, ACC, ACP, educators, CDC, advocacy groups.
- Process: Multiple roundtables and working groups focused on nine key sections representing different facets of patient experience.
- Format: Each section begins with a patient scenario to illustrate real-world challenges, followed by tools, evidence, and practical guidance.
“If we're prioritizing patient experiences, we should really start by talking about the patient experience and start with a very reflective patient scenario at the beginning of each section.” – Dr. Kalyani [15:22]
6. Case Scenarios and Memorable Examples
- Communication Scenario: A patient experiences high blood sugars and delayed provider response, culminating in hospitalization—a sobering reflection of the stakes of communication lapses.
- Telehealth Scenario: A patient cannot show a swollen foot during a video call due to loss of WiFi, highlighting limitations in remote care.
- Hypoglycemia Dashboard: Visual guide to symptoms at varying blood glucose levels, helping patients and providers recognize and prevent severe events.
- Patient Journey Roadmap: Graphic visualizing stages and milestones of diabetes management for better orientation and shared goal-setting.
7. Remaining Gaps and Priorities for the Future
- Unmet Needs:
- New tools required for data integration (from devices to EHRs)
- Better care coordination across specialties
- More culturally and linguistically responsive materials
- Formal inclusion of the patient voice in guideline development
- Ongoing Evolution: As therapies and technologies advance, supportive tools and education must keep pace.
“We need a way to better explicitly capture patients' perspectives and healthcare priorities, not only in day to day management ... but also in development of clinical practice guidelines.” – Dr. Kalyani [21:53]
8. Take-Home Message for Listeners
- Bridging the Gap: Awareness and evidence alone aren’t enough; closing care gaps requires ongoing attention to the patient’s voice and experience.
- Practical Step: Providers should ask: “What are you struggling with? What are your priorities here today?” Simple, direct engagement makes a difference.
“When you're sitting in your clinical visit with the patient in front of you ... just ask them, what are you struggling with? What are your priorities here today? What would you like us to address?” – Dr. Kalyani [23:15]
Notable Quotes & Moments
- “There are also common themes or common challenges that arise throughout the journey of a lifetime of living with this disease...” – Dr. Kalyani [01:25]
- “The challenge is ... that structured intervention is very different than implementation into real world settings.” – Dr. Kalyani [03:01]
- “Those are some examples of some tools that are out there, some guidelines and language that might be more patient centered, not as stigmatizing, free of bias and more inclusive.” – Dr. Kalyani [05:50]
- “The tools can't be burdensome to use in practice because they will just take away otherwise valuable time that the patient and provider have together.” – Dr. Kalyani [08:44]
- “If we're prioritizing patient experiences, we should really start by talking about the patient experience...” – Dr. Kalyani [15:22]
- “We need a way to better explicitly capture patients' perspectives and healthcare priorities, not only in day to day management ... but also in development of clinical practice guidelines.” – Dr. Kalyani [21:53]
- “Simple questions can change the whole conversation and eventually help both the patient and the provider achieve the mutual goal of the best health outcomes possible for people with diabetes.” – Dr. Kalyani [23:23]
Key Timestamps
- 00:00: Introduction and guest welcome
- 01:03: Common patient challenges and global diabetes context
- 02:32: Why patient experiences are overlooked in implementing care standards
- 04:43: Tools for facilitating patient-centered care
- 08:24: Reasons tools are underutilized and ways to increase usage
- 12:34: The development process and broad stakeholder involvement
- 15:13: Structure of the position statement, scenario use, and example scenarios
- 19:20: Unmet needs and future priorities for tools and care strategies
- 22:59: Key takeaway messages for clinicians, patients, and caregivers
- 24:43: Dr. Kalyani discusses her podcast, Diabetes Deconstructed
Final Thoughts
The episode highlights that diabetes management is more than numbers and medicines—it's about understanding the lived experiences of real people. Healthcare tools should be practical and inclusive; communication should be direct and empathetic; and systems should evolve along with therapies and technologies. The new Endocrine Society position statement offers a detailed, scenario-driven blueprint for bridging the “practice gap” with actionable, patient-focused solutions.
For more, listeners are encouraged to read the full position statement and explore further resources listed in the episode notes.