Study: Collaboration and bigger roles by doctors of optometry buttress care for diabetes patients

A new diabetes care study underscores the vital role doctors of optometry have in caring collaboratively for the nation's diabetes patients.

The study was well received by the interdisciplinary audience at the 2018 National Academies of Practice Annual Meeting & Forum, April 13-14 in Atlanta, Georgia. Jointly conducted by the AOA and Johnson & Johnson Vision and its Diabetes Institute, the study was presented by Michael Dueñas, O.D., AOA chief public health officer, and Millicent Knight, O.D., Johnson & Johnson Vision vice president for professional education and development, North America.

For the study, 23 doctors of optometry recruited 95 patients who had not been following their treatment plan for diabetes. Each patient took surveys, prior to the study and after six weeks in the program, to track their progress. To promote diabetes health, doctors of optometry also provided patients with:

• A glucose monitoring system.
• Training by the doctors and their office staff on how to use it.
• Education on the importance of daily self-monitoring of blood glucose.
• Encouragement to reconnect with their primary health care provider, whether it was a general practitioner, nurse practitioner, internist or endocrinologist.

The study found:

• Patient self-care: More patients were engaged in monitoring their blood glucose after six weeks. The number of patients testing daily jumped by 100%, and there was a decline in those who reported initially that they used their blood glucose meters "less than once a month/never."
• Patient re-engagement: About 17% re-engaged with their primary care providers, doctors of optometry or other specialists at the urging of their doctor of optometry. That reconnection encourages an all-hands-on-deck or team approach to caring for patients.
• Patient satisfaction: Patients liked the program, saying they felt "extremely positive" or "very positive" about the meter (54%) and they would "definitely continue" (56%) to use their meters.

"The study demonstrated just how effective doctors of optometry can be in leveraging technology and their offices to improve diabetes care by as much as 100%, as measured by patient survey, among sub-optimally controlled patients with diabetes, seeking care at their facilities," the study's authors say.

Optometry's 'high value' intervention

According to the Centers for Disease Control and Prevention, about 100 million American adults have diabetes and prediabetes. According to a recent report by the American Diabetes Association, diagnosed diabetes is the most costly, chronic disease in the U.S. at $327 billion last year.

Diabetes can be successfully managed with exercise, diet and medication, but many people are unaware that they have the condition or don't check their blood glucose on a daily basis. The study's authors put the latter number at about 50% of people. Yet studies have shown that daily self-monitoring of blood glucose can reduce A1C, which in turn will reduce complications from retinopathy, periodontal disease, obstructive vascular disease, peripheral neuropathies, kidney disease, hearing loss, major depression and Alzheimer's disease.

"Doctors of optometry may help improve health outcomes of persons with diabetes (PWDs), by intervening in their care, when PWDs visit their offices for eye exams and are found to be managing their diabetes sub-optimally," study authors say. "This pilot project enabled doctors of optometry to build relationships and leverage technology to intervene in PWD care."

Adds Dr. Dueñas: "The epidemic increase in diabetes and its associated costs make this intervention by doctors of optometry of high value and worth translating into all optometry practices throughout America."

What doctors of optometry can do

The authors argue there is an opportunity for doctors of optometry, patients and other health care providers to collaborate, leverage technology and create "shared value" that will empower patients and lower health care costs.

"Ultimately, this unique strategy is likely to result in improvement in patient outcomes linked to sustained behavior change and should be considered as an innovative community-wide strategy to improve prevention and care for diabetes-related complications in large populations," the study's authors say.

Paula Newsome, O.D., who participated in the study, agrees.

Dr. Newsome, who practices in Charlotte, North Carolina, already sees many diabetes patients and has historically taken glucometer readings for diabetic patients seeking glasses. Still, her patients in the study told her that she is now sharing more information on their diabetes than their primary health care providers had. Dr. Newsome is now working toward her certification in diabetes education.

"It is always good to empower people regardless of whether you are talking about them testing themselves or any other thing," Dr. Newsome says. "They have automatic buy-in.

"Caring for people with systemic diseases is what we do and how we are trained," she adds. "The eyes are the windows to the body. They are not isolated organs with no connection to the rest of the body."

In 2016, doctors of optometry diagnosed more than 320,000 cases of diabetic retinopathy in patients who did not know they had diabetes.