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The Diabetes Crisis and How PAs Can Help Manage It


Physician assistants can be a key teammate for medical practices in the management, education, and support of diabetic patients.

Diabetes is becoming epidemic. A 2014 Centers for Disease Control and Prevention report estimated that 29 million Americans have diabetes, 25 percent of whom don't yet know they have it. Another 86 million have pre-diabetes, with 90 percent of them unaware of their condition.

There is also a critical shortage of endocrinologists, with three-month wait times for an appointment not at all unusual. That leaves primary-care physicians to shoulder much of the burden of the increasing diabetic population. The good news is that certified PAs can help.

Certified PAs are well-suited to managing diabetic patients because they are highly educated, skilled in patient communications (critical to chronic disease management), and must pass a rigorous exam administered by the National Commission on Certification of Physician Assistants to be licensed in any state.

They can provide vital assistance in this area in a number of ways, including:

Enable Additional Appointments

Certified PAs will increase access for the burgeoning number of patients. In addition, PAs can manage those uncontrolled diabetic patients who often require frequent visits and several days of follow up, which is very difficult for already overscheduled physicians. Having PAs follow up on unstable diabetic patients is a big safety net for both the practice and patients.

Schedule Sufficient Time

Diabetes management is very time consuming, and most physicians struggle with lack of time. Each appointment requires a thorough review of the glucose log, adherence to lifestyle intervention and medication, and discussion of polypharmacy including cost and side effects. Providers need to do foot exam and manage lipids and blood pressure as well. Having a PA dedicated to diabetic management can ease the physician's mind that this time-consuming review is completed during each visit.

Focus on Disease Complexity

The field of diabetes is constantly changing. There were only two available drug classes (insulin and sulfonylureas) in the 1970s, and we now have 11 different classes of medications. As much as we are excited about the flexibility of different options, it is easy to get overwhelmed with "too many" and fall behind with the updates, especially with so many other things primary-care physicians deal with on a day-to-day basis.

A PA designated for diabetes management can focus on staying up-to-date with evidence-based management by attending conferences and CME sessions, and then applying it to patient care. PAs can keep the physician current with the most clinically relevant updates.

Play to Their Strengths

We cultivate a team approach that includes the physician, PA, and patient setting goals for outcomes. Everyone contributes to improve the patient's care. As a PA in endocrinology, my strength is talking to patients who are resistant to certain therapies due to fear or misconceptions. Often, the endocrinologist I work with specifically asks me to talk to a patient who has refused necessary treatments, whether it is insulin therapy, injectable therapy, statin therapy, or something else. I take the time to explain the science, the rationale, and why changes need to be made now. I also try to add some humor to ease the tension.

For example if a patient shows worry or frustration with injectable therapy, I say: "I am actually relieved that you feel this way. I would be more concerned if you were excited to start injections." This usually makes them laugh and opens up the discussion.

Offer Perspective

There are now multiple options in treating diabetes, and each provider has preferences. A PA adds a different perspective in treatment approach. It's another benefit of working as a team - having a second set of eyes on the same patient.

I became enamored with endocrinology during a clinical rotation during my PA education. I saw the joy in my preceptor who worked to motivate patients to change their lifestyle so they could reduce medications, come off insulin and improve their overall health. I realized then that drugs are only a part of medicine. Patient rapport, trust, and relationships are medicine too.

Ji Hyun (CJ) Chun, MPAS, PA-C, practices endocrinology in southern California at Optum Medical Partners. He is secretary of the American Society of Endocrine Physician Assistants (ASEPA) and a faculty member of A.T. Still University.

This blog was provided in partnership with the National Commission on Certification of Physician Assistants.

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