Education as a Diabetes Management Tool

three portraits

Luriza Glynn, APRN, coordinator of UConn Health’s Diabetes Self-Management Education Program, and Drs. Pooja Luthra and Parvathy Madhavan, UConn Health endocrinologists (portraits by Tina Encarnacion) [CLICK IMAGE TO LISTEN TO PODCAST]

Two UConn Health endocrinologists, Drs. Pooja Luthra and Parvathy Madhavan, and the coordinator of UConn Health’s Diabetes Self-Management Education Program, nurse practitioner Luriza Glynn, discuss the importance of recognizing early signs of diabetes and, once diagnosed, managing it with the benefit of education. (Luriza Glynn, Dr. Parvathy Madhavan, Dr. Pooja Luthra, Chris DeFrancesco, April 2023)

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Chris: When it comes to living a healthy life with diabetes, one of the greatest tools is education. Today on the pulse, we discuss the immense difference. UConn Health’s Diabetes Self-Management Education Program can make.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful. I’m Chris DeFrancesco.

Now we’re not breaking ground by stressing the importance of keeping diabetes under control, but in order to do that, you first have to acknowledge you have diabetes. We’re joined by three experts from UConn Health: nurse practitioner Luriza Glynn is coordinator of the Diabetes Self-Management Education Program, and two UConn Health endocrinologists, Dr. Parvathy Madhavan and Dr. Pooja Luthra. Thank you everybody for joining us today.

Dr. Madhavan: Thank you.

Luriza Glynn: Thank you.

Dr. Luthra: It’s our pleasure.

Chris: Let’s start with the underdiagnosed aspect of diabetes, because it’s hard to fight an enemy you don’t know you have. Dr. Madhavan, tell us a little bit about that?

Dr. Madhavan: That’s a great question. So, first of all, we know that almost one in 10 adults in America have diabetes, but almost a quarter of them don’t know that they have diabetes, which is a big number. And almost one-third of adult Americans have prediabetes. And although again, a lot of the patients with prediabetes do not know about it, there is some improvement. In 2008, almost 6.5% of those who had prediabetes knew about it. But by 2020, this has improved to 17.4% of people with prediabetes who now know that they have prediabetes.

Chris: So we’re catching it at almost a three-to-one rate compared to how we used to.

Dr. Madhavan: Yes.

Chris: So that’s progress.

Dr. Madhavan: Yes.

Chris: So let’s talk about prediabetes. What is that and how do you know if you don’t know you have diabetes, if that’s hard to find, how do you find what comes before it? Can you explain how that works?

Dr. Luthra: It is difficult to know in terms of symptoms. When patients have diabetes, we know that they may have some symptoms they may present with. If the sugars are really very high, then patients may present with the unexplained weight loss. They may be going to the bathroom a lot for urination, or they may be very thirsty.

However, prediabetes is a silent condition. Most patients have no idea, so we recommend that if you have risk for developing diabetes, and those risk factors would be if you are overweight or obese. If you belong to certain ethnic groups, like the Asian, South Asian community, African-Americans, or Hispanic community, then your risk of having prediabetes may be high. If you have a family history of diabetes or you have high blood pressure, high cholesterol, if you had gestational diabetes or diabetes that was initially diagnosed in pregnancy, all of that increases your risk.

So if you have those risk factors, you probably want to talk to your primary care physician about getting screening blood testing done. And prediabetes can be diagnosed in a variety of ways. Sometimes you can do something called hemoglobin A1C, or glycated hemoglobin. That’s a blood test that measures the glucose content in the blood. Or you can do a fasting blood glucose, and then some people do other testing or more sophisticated testing to diagnose it. So it’s basically diagnosed on screening testing because it’s otherwise a silent condition.

Chris: I’m gonna go back to, in a little while, the implications of what diabetes can ultimately do, especially if it’s not treated or managed. But before we get to that, let’s talk about what happens when you do have it and you do want to manage it, the education portion of it.

Now, Luriza, you are the program coordinator for UConn Health’s Diabetes Self-Management education program. Explain how that fits into someone who has diabetes, how that can help manage the disease.

Luriza Glynn: So, Chris, keep in mind that diabetes impacts a person in many areas of their lives. And successful self-management involves knowledge across a broad range of topics. And a person who participates in diabetes education can be empowered to take control of their diabetes by gaining the knowledge and skills to manage their condition effectively.

Our diabetes education program provides information and training, regarding healthy eating, benefits of exercise and how to get started with a regimen, blood sugar monitoring or continuous glucose monitoring, if that’s more appropriate, medication management, and coping strategies. We also take great pride in helping women with diabetes prepare for pregnancy.

Chris: Now, getting back to when we talked about the path from prediabetes to diabetes. And then it’s somewhere along that way the person finds out whether he or she actually has it, and then that kind of sets on the trajectory of how to manage it. At what point on the prediabetes-to-diabetes spectrum — and we’re talking type 2 now, right, adult onset — at what point along that spectrum do things start to become irreversible? And is there a point where if you get to the prediabetes stage, you can kind of stop it from progressing and kind of revert back to more of a healthier place?

Dr. Madhavan: So diabetes, prediabetes, and even insulin resistance, and sometimes some other conditions like PCOS, they all fall into the box of metabolic syndrome. And in most cases, you can go from one end of the spectrum to the other end with lifestyle changes. We try to aim for a 5%to 10% body weight loss when someone is diagnosed with metabolic syndrome, and with the great medications that we have available now, that will also help with weight loss. Sometimes even if you have the diagnosis of prediabetes, with adequate amount of weight loss and exercise, you can go into the prediabetes or even insulin-resistant end of the box. But many a time after prolonged, say several decades of having diabetes, sometimes the beta cell function, which is the part of the pancreas that’s making the insulin, can deteriorate. And at that time, patients can develop a need for insulin dependence.

But a lot of time, even patients who are on insulin, with a good amount of weight loss can decrease the amount of insulin that they’re using.

Dr. Luthra: The risk of going from prediabetes to diabetes is a continuum. And anytime when you have substantial weight loss, there can be improvement in the glycemic control and the blood sugar control. I also want to point out that even though the blood sugar control may get better, the risk of dying earlier and having cardiovascular events and stroke, it’s also across the continuum. So it’s very important, even if people have prediabetes, that, one, not only they take good care of themselves and help to lose the weight to reverse that condition, but having prediabetes also puts people at risk for having heart disease and stroke, just like somebody who would have diabetes. So it’s important to pay attention to this condition and not take it lightly, because these are serious health issues.

Chris: Now, do you find, and this could be for any of you, either in the diagnostic portion, the treatment portion, or the education portion — what do you find the biggest challenges are for patients? What do they say are their biggest challenges to try to, because there’s obviously a level of discipline that’s involved, and self-discipline that’s involved, and managing, and a lot of lifestyle decisions that need to go into this to maybe not progress down that continuum as you were saying, but what are some of the biggest challenges that you hear from your patients?

Dr. Luthra: I think it is, as is true with any chronic disease, having chronic disease is difficult to deal with. Especially with diabetes, it takes into account a lot of things that an individual has to manage on a daily basis, including not only making sure they’re making good food choices, making sure they’re exercising regularly, because weight loss, as we all know, is difficult to achieve. So being very disciplined about weight loss, monitoring their food choices, and then regular follow ups with physicians or their other providers, that also involves discipline. Monitoring blood sugars, that’s also one thing that people say, that their fingers hurt because they’ve been monitoring their blood sugars for so long.

Fortunately, we have had a lot of technological advances in monitoring diabetes, and now we have continuous glucose sensors that people can wear on their body and that measures their blood sugar every five minutes. And then obviously, as Dr. Madhavan pointed out earlier, we have lots more medications that are helpful in improving their control and also helping with weight loss. So we have a lot of treatment options in our armamentarium of treatments.

Luriza Glynn: I agree with Dr. Luthra that there are day-to-day decisions that our patients that are affected by diabetes have to make. There’s also a psychosocial and emotional component to all of this, and being aware of that piece — not just with diabetes, but this is with every chronic condition, but especially diabetes — taking the guilt off of their shoulder and really tackling and moving forward what they have to adopt in terms of the self-care behaviors that Dr. Luthra has outlined to gain success, in not only improving their diabetes control, but their overall health. Any person that is a participant or able to participate in a diabetes education program could reduce their A1C by a half of a percent, which is just as good as medication in some instances.

Dr. Madhavan: And adding on to that, it is very difficult to have a behavioral modification without an environmental change. So it really helps when family members are also involved in the care. The person who’s cooking in the house is able to come and meet with our nutritionist part as part of the diabetic education program…

Chris: I could see how that could be very important.

Dr. Madhavan: …could then learn how to make better food choices for the whole family. If another family member is also coming to our education program or even to come to see our endocrinologist, we always counsel about exercise and diet. And if another family member is also involved in doing that, then the environment changes and it’s much easier to implement that behavioral modification. Whether it’s a partner or a child or whoever, or a friend, if someone else is also doing the exercise, it becomes much easier to go along with it.

Chris: We’re actually just about out of time, but I wanted to ask before we say goodbye, anything else, specifically UConn Health offers, either through your program, Luriza, or through the endocrinology practice that folks should know if they’re listening and like, “Oh, you know what, my brother looks like he could probably benefit from giving UConn a call. What’s something that we could leave that person with?

Dr. Luthra: So yes, please make that call. We are here to help you, help you navigate this challenging chronic condition. We will be happy to partner with you, to help you, empower you to be able to live your best life and live a long, healthy life. So, yes, please make that call to us.

Obviously, if you are seeing your primary care providers, please reach out to them. Make sure they test you to see whether you have prediabetes. Can you start implementing those changes early on, and if you have diabetes, what medications and help with the adjustments and the medications that we can make for you? As I had mentioned earlier, there are a lot of new medications which have a lot of exciting data about not only weight loss, but also treatment of cardiovascular disease, kidney protection in patients with diabetes, and we will be able to help you navigate all the medications that are out there for your care.

Dr. Madhavan: And I would just like to add that when you are coming to see the endocrinologist, we not just manage your blood sugar, we also take care of the blood pressure and the cholesterol. We also evaluate foot care and discuss that with the patients. And if there is a threshold, that we are screening you for diabetic kidney disease, we have all the specialties at UConn, including retina specialists, nephrologists, podiatrists, who all are involved in care of a person with diabetes. Neurologists, all those specialties are available at UConn, and we refer them when the time is correct to have all those aspects also taken care of.

Chris: And what is it about diabetes care and education at UConn Health that makes it stand out.

Luriza Glynn: So at UConn Health, we have a comprehensive program that offers both individual sessions as well as group sessions. Our team of experts is comprised of certified diabetes care and education specialists and we provide personalized care to the patients with diabetes that we’re working with. Our goal is to improve the immediate health of our patients and to teach them the skills to remain in good health in the long term.

Chris: And what is the best time to be referred to a diabetes education program?

Luriza Glynn: That’s a great question. When you’re first diagnosed with diabetes is a very important time to get a diabetes education referral. When new complications arise is another time that it would be important to meet with a diabetes educator, any time that your diabetes treatment is changing and anytime you’re not meeting your treatment goals.

Chris: All right. And how is one referred to UConn Health’s Diabetes Education Program?

Luriza Glynn: So we provide diabetes education not only to patients established here at UConn Health, but also from the community. In order for us to provide our service, we do require a referral. And you could find a referral on our UConn Health Diabetes Education Program webpage.

Chris: Right. We’ll have the links and all the information in the notes of this show so we can retrieve best way to get that information, how to contact you, and then more information about the program in general and some other helpful links that you’re going to provide for us as well.

Luriza Glynn: Thank you so much Chris, and I really want to thank you for the opportunity to highlight our program, and for those listeners with diabetes, we look forward to working with you.

Chris: Excellent. That’s Luriza Glynn. You are an APRN and coordinator of the diabetes self-management education program at UConn Health. And we also have heard today from Dr. Pooja Luthra and Dr. Parvathy Madhavan, who are endocrinologists at UConn Health.

That is the time we have for today. I’d like to thank you all for joining me again. For Dr. Madhavan, Dr. Luthra and nurse practitioner Luriza Glynn, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.