Improving Management of Type 2 Diabetes Mellitus - Episode 1

Members of the Diabetes Care Team

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The MD Magazine Peer Exchange "Improving Management of Type 2 Diabetes Mellitus" features a panel of physician experts discussing current best practices to treating and managing patients with T2DM that generally includes lifestyle modifications as well as medication. The mechanisms of action, patient selection criteria, and side effects for various oral medication classes are included in the discussion.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons, and an associate director of Surgical Intensive Care at New York-Presbyterian Hospital.

The panelists are:

  • Robert Busch, MD, director of clinical research in the Community Endocrine Group at Albany Medical Faculty Practice in Albany, NY
  • Ralph DeFronzo, MD, professor of medicine and chief of the diabetes division at the University of Texas Health Science Center in San Antonio, TX
  • Pamela Kushner, MD, clinical professor at UC Irvine Medical Center and director of Kushner Wellness at UC Irvine Medical Center in Los Alamitos, CA
  • Jeffrey Miller, MD, professor of medicine and clinical director of the Division of Endocrinology and Diabetes at Jefferson Medical School in Philadelphia, PA

The segment opens with the panelists discussing the various clinicians that typically make up a diabetes care team and the roles played by each member.

Dr. Busch said that the primary care clinician‑‑whether it’s a physician, nurse practitioner, or physician assistant—is at the hub of the team, “and that’s who’s mainly managing diabetes in the United States.” He also noted that endocrinologists are part of the team occasionally, if needed, as are cardiologists and nephrologists. Ophthalmology is always involved, he said.

The medical assistants, nurses, and phlebotomists who are involved in treating patients with diabetes should be able to recognize what hypoglycemia is.

“It’s really important that we emphasize that diabetes is a lonely place to be for a patient. The primary chief, the captain of that team, is the patient, and we want people to be empowered and to take an active role in the management of their own illness,” said Dr. Kushner. “I would make the captain of the team the patient. I would make the assistants on that team the patient’s family,” she said.

“The way we approach diabetes education in this country at this point is you go to the diabetic educator, you learn how to eat, and that’s it for life. And that’s such an inappropriate way for a chronic disease. This is a chronic condition,” Kushner said.

Pharmacists are also valuable members of the diabetes care team, because they can give support, answer questions, and educate patients about drug interactions when they pick up something over the counter. For many patients, a social worker is also a valuable member of the team.

“What’s also important is a nutritionist—critically important,” said Dr. Miller.