Letters to the Editor  |   July 2010
Empowering Patients During Insulin Initiation: A Real-World Approach
Author Affiliations
  • Vincenzo A. Barbato, OMS IV
    Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
Article Information
Endocrinology / Diabetes
Letters to the Editor   |   July 2010
Empowering Patients During Insulin Initiation: A Real-World Approach
The Journal of the American Osteopathic Association, July 2010, Vol. 110, 396-397. doi:10.7556/jaoa.2010.110.7.396
The Journal of the American Osteopathic Association, July 2010, Vol. 110, 396-397. doi:10.7556/jaoa.2010.110.7.396
To the Editor:  
The clinical practice article in the February issue, written by James R. LaSalle, DO,1 clearly shows that educating patients about their type 2 diabetes mellitus (T2DM)—including the disease process and effective treatment options—will likely give them the power, courage, and confidence to properly manage this condition. After all, the word doctor is derived from the Latin word docre, which means to teach.2 
After serving on clinical rotations for about a year, I have learned much—though, of course, there is still so much more that I need to learn. Because medicine entails a lifelong devotion to learning, I will continue my education process indefinitely. One observation that I have made during my training is that T2DM, like hypertension, is one of those diseases that has the potential to be a silent killer. Many patients do not realize that they have diabetes mellitus until routine blood work is prescribed by their primary care physicians. Results of blood tests may reveal that a patient who has not experienced any adverse symptoms or adverse outcomes is walking around with a fasting blood glucose level of 140 mg/dL. When patients are told that they have diabetes mellitus, I hear time and time again the same response: “But I feel fine, doc!” 
As a fourth-year osteopathic medical student, I have had many opportunities to observe physician-patient interactions. Unfortunately, my observations have demonstrated that, more times than not, the conversation ends when the patient finds out that he or she has diabetes mellitus. Typically, the physician will scribble down treatment on a prescription pad and perhaps—if the patient is lucky—also explain a couple of the adverse outcomes of uncontrolled diabetes mellitus. Needless to say, the patient is not appropriately educated in this approach. 
I understand that many physicians are overworked and overwhelmed by the amount of patients that they have to see everyday. However, spending an extra 10 to 15 minutes with a patient who is newly diagnosed as having T2DM—or any disease for that matter—can really go a long way in helping the patient understand and cope with this disease. 
Dr LaSalle1 mentions the importance of certified diabetes educators (CDEs) and the barriers that physicians and patients face in using these professionals as part of treatment strategies for diabetes mellitus. These specialized educators can indeed play a crucial role in the ongoing management of diabetes mellitus. Nevertheless, the use of CDEs does not absolve physicians of the responsibility of taking a few extra minutes to educate a patient about diabetes mellitus within the first few office visits after diagnosis. One benefit of giving patients such extra attention is that it will demonstrate that the physician truly cares and advocates for the patient. Furthermore, according to Romayne Gallagher, MD,2 the following six points should be kept in mind to promote patients' health literacy and to help patients understand their disease process, adhere to their treatments, and improve their outcome: 
  • Slow down when speaking to patients.
  • Use plain, nonmedical language.
  • Show or draw pictures—visual pictures with an explanation [are] best.
  • Limit the amount of information provided and repeat it.
  • Confirm that patients understand by asking them to repeat instructions to you.
  • Be open to patients asking questions.
Although educating patients will require that more time be spent with them, this extra time will ultimately give the patients more empowerment and confidence to successfully manage their diabetes mellitus. As Dr LaSalle1 states: 

Evidence indicates that empowering patients to take greater control of their diabetes mellitus through education and patient-oriented insulin titration regimens may improve glycemic control and reduce the risk of complications.

As physicians—regardless of specialty or affiliation with osteopathic or allopathic medicine—we should want our patients to be given all possible opportunities to succeed in the fight against disease. When they do succeed, we can take pride in the fact that all our hard work, as well as the patients' own efforts, paid off. We should do everything that we can to heal and to have positive impacts on our patients' lives. Isn't this the reason that we dedicated our lives to medicine in the first place? 
LaSalle JR. Empowering patients during insulin initiation: a real-world approach. J Am Osteopath Assoc. 2010;110(2):69-78. Accessed June 14, 2010.
Gallagher R. How to improve our patients' health literacy. BCMJ. 2008;50(9):525-526. Accessed June 14, 2010.