RUNNING HEAD: Diabetes in the Community 1

Diabetes in the Community: How to Better Serve this Population

Delaware Technical Community College

Lindsay O’Hara

Nur 330- 2W1

November 28, 2018

Diabetes in the Community- How to better serve this population 2

Diabetes in the Local Community

Since becoming a nurse and working on a general medicine floor of the major hospital on

the Eastern Shore, I have seen a wide range of health disparities. One chronic disease that I see

time and time again is Diabetes and complications that arise from mismanagement. Diabetes is

very prevalent in the community I serve. According to Peninsula Regional Medical Center

(2018), 9.6% of the population within Wicomico County have diabetes, which is lower than the

state average of 10.2, but the trend is going up. The surrounding counties of Somerset and

Worcester also had trends that were climbing. The Eastern Shore is an awesome place to live

with some of the nicest people within the community, but one thing I found is that our

community is terrible when it comes to health care. Diabetes is a lifelong disease that requires

management consistently. Many of our elderly do not even have a primary care physician, let

alone an endocrinologist that helps them manage their diabetes. This is one of the major reasons

I have chosen to do my practicum in diabetes education. I think education first and foremost is

the most important thing for this community, especially patients with chronic illnesses such as

diabetes. If we as health care workers are able to help educate our local community on the

importance of routine health care, we may be able to prevent hospitalizations and keep our

community healthy.

Background

Diabetes is a disease that does not discriminate. It affects all ages, races, and genders.

There are non-modifiable risk factors that are associated with diabetes such as family history and

certain races are more likely to develop diabetes, but the modifiable risks are manageable.

Healthy diet, exercise and most importantly, continuity of care and management. According the
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Creating Healthy Communities dashboard, Peninsula Regional Medical Center saw 373 patients

per 100,000 people from Wicomico County for diabetes related illness in the emergency room in

2014. The average for the state was 204 cases. According to the CDC, Wicomico County had the

second highest rate of diagnosed adults with diabetes. Through assessment data, I found that

there were three main concerns that were barriers to this population- education, obesity, and lack

of insurance and knowledge of resources.

Assessment

It is no secret that the Eastern Shore is a place to vacation and relax, but we also have an

above average obesity rate for the state. Obesity is one of the main contributors to diabetes. “In

the last 20 years, the number of adults diagnosed with diabetes has more than tripled as the

American population has aged and become more overweight or obese” (CDC, 2018). The

obesity rate for Wicomico County in 2016 was 70.1 %, which was higher than the state average

of 68. 1% (Peninsula Regional Medical Center, 2018). This modifiable risk is at top of the list of

ways to keep diabetes from becoming out of control. It’s important for patients to understand

why a healthy diet and exercise are so important to their daily routine.

Growing up, I know it was always important to routinely go to the doctor and have an

annual physical. Throughout my interactions with the elderly community, I found there is huge is

huge gap in basic education. Some of these patients believe you only went to the doctor if you

absolutely had to. The Medicare population is undereducated. According to Peninsula Regional

Medical Center (2018), 82% of the Medicare population in Wicomico County has a high school

degree or less. The Medicare population is one of the biggest and growing population out there.

It is extremely important to educate these patients in the importance of routine monitoring.

Patients with diabetes need to have quarterly check-ups, as well as annual eye exams, and know
Diabetes in the Community- How to better serve this population 4

the signs and symptoms of hyperglycemia and hypoglycemia. Upon admission, we screen all

patients for diabetes. If the patient is a diabetic, we ask if they know how to check their blood

sugar, dietary restrictions, how to care for their feet, when to call the doctor, etc. Quite often, a

lot of diabetic patients are unable to answer these questions, or they answer them incorrectly.

Education is the most empowering tool any patient can have.

Education and obesity were main concerns, but there was a portion of the patients that

were uninsured or underinsured. Some of these patients elected to not seek routine medical care

at all and some used the emergency room as their medical provider. 11.5% of the population in

Wicomico County reported not going to see a doctor due the financial burden it would place on

them. 9.9% of the emergency room visits at Peninsula Regional Medical Center in 2014 were

from uninsured patients (Peninsula Regional Medical Center, 2018). No one should have to

choose between putting food on the table for their family or seeing a doctor for health care.

Plan/Interventions

After working with this community for the past 18 months, and specifically working with

the Diabetes Education department at Peninsula Regional Medical Center, I thought of some

improved interventions that may assist with preventing this vulnerable population with

hospitalizations and routine monitoring. Diabetes requires a lot of self-monitoring and discipline.

“Multiple studies have found that DSME is associated with improved diabetes knowledge,

improved self-care behavior (1), improved clinical outcomes, such as lower A1C (3,6–8), lower

self-reported weight (9,10), improved quality of life (8,11), healthy coping (12,13), and lower

costs” (American Diabetes Association, 2015). Education is the most important tool a patient can

have. If the patient has the proper education, modifiable risk factors can be reduced. In

conjunction with admission checklist already in place, once the admitting nurse identifies that a
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patient is a diabetic, this should automatically trigger a consult for the diabetes education

department. The certified diabetes educators will be able to better assess the needs of the patient

and help guide the nurses in which education to hone in one. During the assessment, the CDE

can make sure the patients have all the necessary materials for testing blood sugars, if not, the

physician can order the appropriate materials that can be cost effective for the patient. Right

now, there is a generic Diabetes Education book that is provided to each patient. If each patient

is assessed properly by a CDE, the nurses will be able to focus their education on problem areas

New literature focusing on each of the major diabetic complications- retinopathy, neuropathy,

wound care, insulin dosage when ill, etc., should be distributed appropriately.

Upon discharge, Hemoglobin A1C will be drawn for comparison at a later date. If the

patient’s insurance allows, the patient should be enrolled in diabetes education classes. Right

now, these classes are offered in a 5 series, which not many patients finish the complete course.

Time constraints or non-compliance were listed as the main reasons for not completing the

classes. Condensing the classes, or after the focused assessment, have participants sign up for

classes in areas that they particularly struggle with. At the completion on the classes, each

participant should write down 3 goals that wish to achieve within 3 months. A follow up

telephone interview 3 months after the classes should be made to check in with the patients and

see how they are progressing and if their goals have been achieved.

Uninsured and underinsured patients will always be a problem for the emergency room. It

is one of the only options that these patients have. PRMC currently is offering a bridge clinic for

those patients who have no established themselves with a primary care physician and need a

routine follow up. It’s important that a doctor follow these patients and helps monitor their

progress with their diabetes care. Care coordinators can help establish appointments for these
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patients and community care workers can help ensure patients do not have any issues getting to

and from appointments. Diabetes education can be reinforced for these patients who are unable

to attend educational classes.

Evaluation

Three month follow up for all diabetic patients should be scheduled with Diabetes

Education. It can be via telephone or in person for those who feel they need a face to face

encounter. Hemoglobin A1C will be drawn and be compared to A1C drawn prior to beginning of

education classes and discharge.

Conclusion

Diabetes is on the rise in my community and the past few months have shown me that

these patients really need education. With proper education and knowledge of resources, the

diabetes-related hospitalizations may decrease. The community I serve is a great community, and

I want to ensure that they stay healthy by promoting education and healthy living.
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References

American Diabetes Association. (2015). Foundations of Care: Education, Nutrition, Physical

Activity, Smoking Cessation, Psychosocial Care, and Immunization. Diabetes Care, 38,

20-30. https://doi.org/10.2337/dc15-S007

Centers for Disease Control and Prevention. (2018). Diabetes. Retrieved from

https://www.cdc.gov/diabetes/home/index.html

Peninsula Regional Medical Center. (2018). Creating Healthy Communities. Retrieved from

https://www.peninsula.org/community/creating-healthy-communities