5 ways to improve diabetes care at hospitals

By Dr. Barbara Keber

As a physician specializing in family medicine, I've seen firsthand the challenges diabetes patients face when they require hospitalization.

Improving the care these patients receive is a critical focus, and I believe every hospital can hospitalized patients living with diabetes benefit from adopting strategies that address the multifaceted nature of diabetes. It’s not just about treating the immediate reason for admission; it's about recognizing and addressing the underlying condition that can exacerbate other health issues.

Here are five key areas where hospitals can make substantial improvements in diabetes care, ultimately enhancing patients' quality of life:

Standardizing Care: Inconsistent treatment can have devastating consequences for hospitalized patients living with diabetes. Standardized prewritten prescriptions, or order sets, can provide clear directions for medication and other treatments based on the latest medical guidelines. This standardization ensures consistency and reduces the risk of errors or oversights. For example, when a steroid is prescribed – which can elevate blood sugar levels – order sets can automatically trigger frequent glucose testing for the next two days. This system safeguards against potential complications across a wide range of clinical scenarios where steroids might be necessary.

Focusing on Education: Effective diabetes management depends on a multifaceted understanding of diet, exercise, medication, and stress management. A comprehensive diabetes education program can empower patients to take control of their health. Training front-line team members as “diabetes champions” can provide immediate support and guidance to patients. Certified diabetes educators can offer advanced support for complex cases, and social workers specializing in diabetes education can address socioeconomic barriers that can hinder effective management. Education is paramount in preventing complications, and efforts should be made to ensure that language barriers and other obstacles don't impede a patient's understanding and ability to manage their condition.

Breaking Down Barriers to Care: Social determinants of health, such as limited income, can create significant challenges for those living with diabetes. Hospitals can actively work to mitigate these barriers by offering extended clinic hours to accommodate work schedules, providing assistance with medication costs through coupons and discount programs, and even helping with transportation to appointments when possible. Partnering with organizations that provide access to essential medications can further alleviate the financial burden on patients.

Addressing Racial Disparities: We must acknowledge that racial and ethnic disparities exist in diabetes care. Black and Hispanic Americans are at higher risk of developing diabetes and often face greater hurdles in managing their condition effectively. Research indicates that cultural competency training for healthcare professionals is essential to bridge these gaps. This includes sensitivity to language barriers, dietary preferences, and health literacy levels. Increased awareness among staff about these disparities is also crucial.

Ways in which we are able to address these barriers include the use of interpreters via either telephone line or especially with associated video for those situations in which patients are learning about the ways to use various equipment and devices such as glucose meters, continuous glucose monitors or insulin pumps. Assessment of all patients for social determinants of health such as food insecurity, transportation difficulty or lack of housing stability also add to the resources that can be offered to assist patients in controlling their blood sugars. This contributes to improved outcomes and fewer complications.

Creating a Network of Support: Effective diabetes care requires a collaborative approach. Fostering a culture of shared responsibility, where every team member is trained to recognize and respond to diabetes-related concerns, creates a safety net for patients, ensuring that potential issues are addressed promptly.

These five pillars, combined with a commitment to exploring and implementing new technologies like continuous glucose monitoring (CGM), demonstrate a dedication to improving the lives of patients living with diabetes. While CGM awaits full FDA approval for inpatient use, it has the potential to revolutionize how we manage blood sugar levels, particularly in vulnerable populations like pregnant women and surgical patients.

Barbara Keber, MD, FAAFP is Northwell Glen Cove’s Chair of Family Medicine.