ODs important members of diabetes management team
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Louis H. Philipson, MD, presented a series of diabetes calls to action for optometrists during a multidisciplinary-focused plenary session at the virtual American Academy of Optometry meeting.
“What we worry about with diabetes are complications. There’s heart disease, end-stage renal disease, and it is one of the leading causes of blindness in working-age adults,” Philipson, James Tyree Professor of Diabetes Research and Care at the University of Chicago, said during his presentation. “These calls to action are things that optometrists can hang onto in their armamentarium of procedures for their patients with possibly diabetes-related eye disease.”
Philipson advised that patients with diabetes should be educated about the long-term benefits of meeting glucose targets to reduce the risk for and progression of diabetic retinopathy.
Women with preexisting diabetes should be counseled about the risk for retinopathy during pregnancy. Philipson recommended that they have an eye and vision exam before pregnancy and then in each trimester with follow-up 6 to 12 months postpartum. However, because gestational diabetes is temporary, is does not lead to diabetic retinopathy.
“People without a diagnosis of diabetes who present with signs or symptoms suggestive of diabetes during an eye exam should have appropriate follow-up,” he said. “This may include A1C or glucose testing or referral to their primary care physician. These are the symptoms that many of us know but sometimes forget: frequent urination, increased thirst, blurry vision, extreme fatigue, unexplained weight loss, slow-to-heal wounds and darkening of skin.”
Philipson also noted that the causes of hyperglycemia include not enough insulin or oral diabetes medications, side effects from other medications such as steroids, too much food intake, physical inactivity, dehydration and illness.
In contrast, hypoglycemia is caused by too much insulin or other rare conditions. He discussed the Fremantle Diabetes phase 2 study in which prior severe hypoglycemia was recently reported to be the greatest predictor of diabetes-related vision loss. Patients who experienced a severe hypoglycemic event before the study were five times more likely to lose their vision within the 4-year study period (OR = 5.59; 95% CI, 1.32-23.61).
“To help identify patients experiencing hypoglycemia, the optometric office staff should be alert for hypoglycemic symptoms,” Philipson said. “It may be prudent for optometry offices to maintain a blood glucose meter and single-use lancet devices to confirm hypoglycemia and its resolution, where state laws permit.”
He also said that optometry offices should keep rapid-acting carbohydrates in their office for use by patients with diabetes who experience acute hypoglycemia during an eye exam.
“The diabetes care team is everyone who sees that person and their family — doctors, nurses and diabetes care educators including dieticians and nutritionists. Additionally, I cannot emphasize enough the mental health professionals,” Philipson said. “We want bidirectional communication between specialists and primary care, especially considering some patients may not have easy access to an endocrinologist.”
The list of barriers to seeking care and self-management of diabetes is long, he said, and can include language and understanding, depression and mental illness, stress and difficult home life, substance abuse, self-care burnout, cultural beliefs and attitudes, and fear of shame.
“For people with diabetes, language is important. I try not to use even the word ‘diabetic’ anymore, because people are not their disease,” Philipson said. “We try to use language that’s neutral and nonjudgmental. People have diabetes, diabetes does not have them.”
Reference:
- Drinkwater JJ, et al. J Diabetes Complications. 2020;34:107560.
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Philipson LH. Focus on diabetes: An overview for optometrists. Presented at: American Academy of Optometry meeting; October 7-22, 2020; virtual meeting.
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