Diabetes and the Role of Lifestyle Coaching

Gwen Wagner

Gwen Wagner

Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Health Partnership Clinic

There’s a combination of factors that help someone with diabetes get control of their blood sugar and reach their target A1C, which is typically 7.0% or lower. An A1C is sometimes referred to as the “three-month blood sugar” as it reflects the average blood sugar the patient has had over the past three months. Lifestyle changes and a multidisciplinary team approach play a key role.

Lifestyle Changes

Several of our patients from the High-Risk Diabetes Clinic (HRDC) at Health Partnership Clinic (HPC) have attributed their success in controlling their diabetes to factors such as being able to obtain access to affordable medication and receiving diabetes education. However, probably the most common factor that patients have identified has helped, is being coached on how to adjust their lifestyle. Every individual is different, and it is important to address the diet, exercise and lifestyle challenges of each patient. Having support in incorporating lifestyle changes is key to being successful in reaching and maintaining a normal A1C.

Patients in our diabetes clinic are fortunate to benefit from interaction with a Behavioral Health Clinician (BHC) who helps them address their challenges in controlling their diabetes which often includes help managing situational stressors and depression as well as making sustainable changes to their lifestyle.

“Often times we receive referrals to our HRDC due to “non-compliance,” says Cecilia Ponce, LSCSW, Behavioral Health Clinician. “When we speak to our patients about their barriers, we receive a wide range of responses: finances, transportation, knowledge, lack of support, cultural beliefs, lapse, relapse, difficulty maintaining change, adjustment to life changes, holidays, depression, anxiety, grief and loss, trauma, fear, side effects from medications in the past, physiological changes and so much more.”

Ponce,Cecilia

Cecilia Ponce

Cecilia adds “Diabetes is a chronic illness and interventions to help our patients must address potential changes across the lifespan. The beauty of a true integrated model is that not only do we try to address what the patient is presenting with now; we are able to assess pitfalls in the past and empower them to implement their skills now and in the future.”

Multidisciplinary Team Approach

The American Diabetes Association publishes a document each year entitled “Standards of Care”, which outlines the most effective practices in diabetes care. They recommend that diabetes care should be managed by a multidisciplinary team and that lifestyle management should be a focus, not only at the time of diagnosis but as a part of all subsequent visits as well. Diabetes is not a static disease, and individuals often are presented with new challenges or changes in their lives that affect their diabetes and that need to be addressed.

We are fortunate to have BHC’s on our staff and as part of our Diabetes clinic. We believe that taking a holistic, integrated approach to health care provides the best outcomes for our patients and helps them achieve their goals.

HPC is accepting new patients of all ages. Call 913-648-2266 today.

HPC - Diabetes Lifestyle Coaching

HPC Provides Individuals with Comprehensive Diabetes Care

Gwen Wagner

Gwen Wagner

Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Health Partnership Clinic

In response to a challenge from Health Resources and Services Administration (HRSA) to create a quality improvement plan to address the number of patients with uncontrolled diabetes, HPC started a focused High-Risk Diabetes Clinic (HRDC) in August 2018. It takes place on Mondays and is open to any patient with an A1C greater than or equal to nine. An A1C is sometimes referred to as the “three-month blood sugar” as it reflects the average blood sugar the patient has had over the past three months. The goal for a person with diabetes per the American Diabetes Association (ADA) is to have an A1C of seven or lower. At present there are 100 patients participating in the HRDC.

There are three goals of the HRDC:

  • To improve patients understanding of effective lifestyle change and to assess and address psycho-social barriers to diabetes care.
  • To provide additional education and support for diabetes self-care especially with regards to insulin administration.
  • To remove financial barriers to obtaining insulin for self-administration and diabetes treatment.

Helping patients control their diabetes is not as simple as just providing medication or telling someone not to eat sugary foods. Diabetes can be a complex and multifaceted disease and patients need not only medication but education, counseling, support and self-management tools so that they can become experts in controlling their own blood sugars.

At HPC, we recognized the need for more comprehensive care and started the HRDC for those patients with uncontrolled blood sugars.

In the HRDC, we focus on education, counseling, mental and behavioral support along with medication management. This provides patients with comprehensive diabetes care and ultimately helps improve their quality of life. Lifestyle management is a fundamental aspect of diabetes care, and we focus on helping patients address risk factors and implement dietary and physical activity changes.

Diabetes self-management education focuses on providing individuals with the knowledge and tools they need to improve their control of diabetes. Patients are encouraged to check daily blood sugars, learn to recognize the signs of blood sugars that are too high or low and then learn how to manage those situations. They are taught how to take their medications safely, particularly insulin and even how to adjust insulin doses at home. Information about foot care and a variety of other topics are also addressed. Lastly, during clinic time a medical provider will perform necessary physical assessments and provide medication management tailored to the individual’s needs.

Medications for diabetes can be very expensive for those both with and without insurance. However, several medications prescribed are made affordable through an assistance program called the 340 B plan and through our association with AuBurn Pharmacy in Olathe. We also have been able to assist patients to obtain insulin when necessary for blood sugar control.

Results

The Team

Special thanks to the team: Jessica Grate, MA, Adrianna Lund, MA, Cecilia Ponce, LSCSW, Behavioral Health Consultant, Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner.

Since starting the clinic, over half of our patients have A1Cs that have now fallen below nine percent, with an average individual decrease in A1C of approximately two percent. Our overall percentage of patients with diabetes who are considered “uncontrolled” (an A1C greater than nine) has dropped from 43 percent to 33 percent since the clinic began.

We hope to continue to support our patients with diabetes with the tools and resources they need to improve control of their diabetes and as a result, improve the quality of their lives.

Knowledge is Key in the Fight Against Diabetes

Gwen Wagner

Gwen Wagner

Post written by Gwenyth Wagner, DNP, APRN

November is National Diabetes Month.

This month, organizations across the country will band together to bring awareness about prediabetes and diabetes which affects more than 100 million U.S. Adults.

According to the Centers for Disease Control and Prevention (CDC) 30.3 million people in the United States have Diabetes, and 84.1 million people have Prediabetes.

You are at risk for developing prediabetes if you:

  • Are overweight
  • Are 45 years or older
  • Have a parent, brother, or sister with type 2 diabetes
  • Are physically active less than three times a week
  • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than nine pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

The good news is that you can prevent or reverse prediabetes with lifestyle changes such as losing weight if you are overweight, eating healthier and getting regular physical activity.

If you have been diagnosed with diabetes, it is important to eat well. The first step is to make an appointment with your health care provider and discuss what changes you can make to your diet to improve your health.

The CDC recommends that half of your nine-inch plate be filled with non-starchy vegetables like leafy greens, green beans, broccoli, cauliflower, or carrots.

One-quarter of your plate should contain lean protein such as chicken, fish or lean beef. The remaining one-quarter of your plate should contain a whole grain or starchy vegetables such as potatoes, corn, peas or winter squash. You can also eat a small amount of fresh fruit.

Diabetes graphic

When you are grocery shopping, your cart should look like your plate. Half of your food items should be non-starchy vegetables like lettuce, asparagus, broccoli, cauliflower, cucumber, spinach, mushrooms, onions and peppers.

The rest of the cart should have lean proteins, whole grains, fruit, dairy, beans and starchy vegetables such as corn, peas, parsnips, potatoes, pumpkin, squash, zucchini and yams.

Here are a few tips to make grocery shopping easier:

  • Don’t go to the store hungry.
  • Make a list before you go to the store.
  • Shop the perimeter of the store first. This is usually where the healthiest foods are located!
  • Don’t purchase items that are not in your meal plan.
  • If you have favorite foods, discuss with your dietitian, how to manage eating them occasionally.
  • While at the store, don’t linger in aisles with tempting foods.

For more information and helpful tips about managing your diabetes, visit the CDC’s website at https://www.cdc.gov/diabetes/home/index.html.

To find out if you are prediabetic, take the quiz at www.preventdiabeteskc.com. This website is also a source for Diabetes Prevention Programs in the Kansas City area. Juntos provides Diabetes Prevention Classes in Spanish at HPC. Call today to find out how you can register…913-725-8676!

At HPC, we provide patient education and chronic disease management.  Though dietary measures are key in prevention and can be helpful in controlling diabetes, diet changes alone are not always enough to manage this disease. Be sure to talk to your provider about what treatment is best for you. To schedule an appointment to see a provider, call 913-648-2266.

Know Your Numbers – What is Your Risk for Diabetes?

Author: Daphne Ayn Bascom, MD PhD
Senior Vice President, Community Integrated Health
YMCA of Greater Kansas City

Dr Daphne Bascom

Daphne Ayn Bascom, MD PhD

As diabetes rates continue to rise, do you know your risk?

The YMCA of Greater Kansas City is encouraging the community to learn about the risks for prediabetes and type 2 diabetes and adopt healthy habits.

Take these three preventive steps to potentially avoid developing the disease:

  1. Learn about prediabetes.
  2. Assess your risks.
  3. Make small changes to your lifestyle.

You likely already know someone affected by diabetes or prediabetes, or are affected yourself. Statistics from the Centers for Disease Control and Prevention (CDC) show that more than one in three Americans (84 million people) have prediabetes.

Prediabetes is a condition in which a person’s blood glucose is elevated, but not high enough for a diagnosis of diabetes. Only 10 percent of those with prediabetes know they have it. But with awareness and simple actions, people with prediabetes may prevent the onset of type 2 diabetes.

LOCAL IMPACT

In Kansas and Missouri, we have an opportunity to take charge of our health and educate others about diabetes and prediabetes. Diabetes rates continue to rise, and the rates of people with diabetes and prediabetes in Missouri and Kansas are higher than the national averages.

Missouri

  • 13.2 percent of the adult population (approximately 699,992 people), have diabetes, compared to 9.4 percent of the total US population.
  • Of these, an estimated 152,000 have diabetes but don’t know it.
  • 35.9 percent of the adult population (1.6 million people), have prediabetes, compared to 33 percent nationwide.
  • Every year an estimated 32,000 people in Missouri are diagnosed with diabetes.

Kansas

  • 12.6 percent of the adult population (approximately 293,860 people), have diabetes, compared to 9.4 percent nationwide.
  • Of these, an estimated 69,000 have diabetes but don’t know it.
  • 35.5 percent of the adult population (749,000 people in Kansas), have prediabetes, compared to 33 percent nationwide.
  • Every year an estimated 15,000 people in Kansas are diagnosed with diabetes.

TAKE ACTION FOR YOUR HEALTH

YMCA Guest Blog DPP Flyer Pic 2As one of the leading community-based charities committed to improving the health of the greater Kansas City area, the Y wants members of our community to understand their risk for prediabetes and to take steps to avoid developing type 2 diabetes.

Developing type 2 diabetes not only puts a tremendous strain on our health care system but impacts the lives of millions of people and their families each year.

Assess your risk for prediabetes and type 2 diabetes by taking a simple test at YMCA.net/diabetes. Through this assessment, you can also learn how lifestyle choices and family history help determine the ultimate risk of developing the disease.

Making some basic lifestyle changes that contribute to weight loss and healthy living can decrease the risk of type 2 diabetes.

  • Eat fruits and vegetables every day. A plant-strong diet is a great way of reducing your risk.
  • Choose fish, lean meats and poultry without skin.
  • Aim for whole grains with every meal.
  • Be moderately active, getting at least 150 minutes of physical activity each week.
  • Choose water to drink instead of beverages with added sugar.
  • Sleep is an important part of your health and well-being. Good sleep hygiene can help reduce your risk of diabetes and obesity.
  • Speak to your doctor about your diabetes risk factors, especially if you have a family history or are overweight.

THE Y IS HERE TO HELP

The YMCA of Greater Kansas City is helping to improve the health of our community. We offer programs including the YMCA Diabetes Prevention Program and the Y Weight Loss Program.

We also offer additional programs and seminars designed to help you make small lifestyle changes that can help improve your health and reduce your risk of developing chronic diseases such as type 2 diabetes. Membership at the Y is NOT required to participate in many of these programs.

To learn more about the YMCA of Greater Kansas City’s Health and Wellness Programs, please contact program coordinators Madison Eiberger or Rubi Lopez at HealthyCommunity@KansasCityYMCA.org or 816-285-8050.