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Healio
Issue: March 2018
ByMichael D. DePaolis, OD, FAAO
March 15, 2018
2 min read
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It takes a village to manage diabetes

Issue: March 2018
ByMichael D. DePaolis, OD, FAAO

In a June 2016 webcast, the American Journal of Managed Care convened a group of endocrinologists to discuss our country’s diabetes crisis. As of 2015, the American Diabetes Association reported that 30 million Americans have diabetes, another 1.5 million new cases are diagnosed annually, and a staggering additional 84 million adults have prediabetes. The cost to society is unfathomable, with diabetes being the seventh leading cause of mortality, contributing to some 250,000 deaths each year.

During the webcast, a number of strategies for ebbing the diabetes epidemic were discussed, including: reengineering society (think less sedentary workplaces and fewer sugary beverages), tailoring treatment regimens (as any therapy is valuable only if it’s achievable for that specific person) and deriving synergy from collaborative resources (to ensure an all-hands-on-board, patient-centric approach). In fact, the webcast’s spirit was perfectly summarized by Dr. Robert Gabbay, when he stated, “It’s an incredibly dynamic time in the world of diabetes, and I think there’s this amazing opportunity with the new tools, new treatments, with partnerships and, really, this idea of, ‘It takes a village.’”

Michael D. DePaolis

The concept of it taking a village is not a new one. Often attributed to an ancient African proverb, finding the quote’s true origin has proven rather evasive. The reality is that there are a number of citations, from a variety of African nations, which loosely translate into “it takes a village.” As I see it, all the better. Clearly, the concept of a collaborative effort for the betterment of a cause – be it raising a child or caring for someone with diabetes – has withstood the test of time. So, what does this have to do with optometry? Well, as it turns out, we’re very much a part of the village.

As optometrists, we might be the only health care provider many 40-year-old pre-diabetic males see. And, as optometrists, our primary care and endocrinology colleagues rely on us to provide valuable information on existing diabetic patients’ vascular status. And, perhaps most importantly, we are perfectly well positioned to further deliver the message. Asking about A1c and medication compliance, discussing the eye’s role as a surrogate marker and emphasizing the importance of lifestyle and diet all go a long way in supporting the village’s cause – a cause that has become increasingly important, as fewer than 50% of diabetics achieve ideal glycemic control.

With improved compliance as a top priority, it’s clear our village needs more effective strategies. While optometrists will remain committed to annual dilated exams, corresponding with other team members and educating patients, our role continues to evolve. In this month’s feature article, “Interprofessional diabetes care improves with communication, regular screening”, we take a closer look at optometry’s place in diabetes management. While it will take some time to build consensus on technologies ranging from OCT-A to telescreening, it’s imperative we collectively get it right. Otherwise, with more than 80 million pre-diabetics in our midst, our village could easily be overwhelmed.