Individualized education most effective for hypoglycemia prevention

NEW ORLEANS — Individualized diabetes self-management education is essential in preventing hypoglycemia among patients with diabetes, according to two presenters at the American Association of Diabetes Educators Annual Meeting.

Two recent studies showed that although glucose control has been improving nationally, events of hypoglycemia and insulin mistakes that result in emergency care are common.

“Diabetes self-management is more complex than most people realize,” Linda Gottfredson, PhD, professor of education at the University of Delaware, told Endocrine Today. “Certainly, from the patient’s point of view, it’s extremely complex. You’re constantly having to deal with ambiguous circumstances — things that are not facts that you can teach, but you have to apply what you know, when to intervene to prevent a problem, how to do so — these are all factors that make some jobs extraordinarily complex.”

During the presentation, Gottfredson and Kathy Stroh, MS, RD, LDN, CDE, of Westside Family Healthcare in Wilmington, Delaware, discussed an action plan to prevent adverse drugs events and strategies to prevent hypoglycemia among patients with diabetes.

In 2014, the HHS released the National Action Plan for Adverse Drug Event Prevention, which included a section on diabetes agents.

“The national action plan to prevent adverse events was a big document that incorporated several federal agencies,” Stroh told Endocrine Today. “Certified diabetes educators (CDEs) coordinated the response from all the different agencies to create a guidance document we used in identifying the problems with currently used strategies.”

In the report, intensive treatment and misunderstanding of administration are common contributors to adverse drug events with diabetes drugs. Further, the complexity of diabetes drugs also can influence medication adherence.

Gottfredson and Stroh said diabetes self-management education (DSME) has many different elements, and individualized care is important for ensuring that all patients understand the many different elements involved with diabetes education, as well as medication adherence.

“What our focus is, is deconstructing the common sorts of errors that patients make, and if you look at errors, they are cognitive errors — a failure to understand, to reason, to spot problems and to figure out what’s relevant in solving them,” Gottfredson said.

Educators and patients must understand the complexity of the task and the educational objective to order the particular building blocks of any activity, she said. For example, patients must learn the basics of calorie counting and when to take insulin around meals before adjusting insulin based on diet and exercise.

“What’s common is they think of one factor and not two,” Gottfredson said. “They don’t put them together, so our efforts are to create an instructional method and guides in order to help CDEs and other providers figure out which tasks are most critical for a particular patient to prevent hypoglycemia.”

Gottfredson and Stroh said it is important to be clear when teaching DSME and that not all patients will learn at the same pace.

“Diabetes is the only disease that has a credential attached to it — CDEs — so what we did is recognize that everyone is concerned about preventing hypoglycemia,” Stroh said. “You can’t expect an overworked provider to spend an additional 20 to 30 minutes talking to the patient about what caused them to go to the ED with their low blood sugar. CDEs are perfectly positioned to do this. If not us, then who else? We’re ready, we’re equipped to take on the challenge, and now we have an additional [strategy] to do it.” – by Amber Cox

Reference:

Gottfredson L, Stroh K. W01. Presented at: The American Association of Diabetes Educators Annual Meeting; Aug. 5-8, 2015; New Orleans.

Disclosure: The researchers report no relevant financial disclosures.