Diabetes care team: assemble

Bellwether isn't normally a word associated with rural Chattahoochee, Florida. That is, except when it comes to diabetes care.

Nearly three decades ago, Chattahoochee—designated a health professional shortage area—enjoyed the luxury of having its only doctor of optometry in an office duplex alongside the town's only dentist; across the street, its only pharmacy. It was an exercise in convenience and an opportunity for care, says Michael Dueñas, O.D., AOA's Chief Public Health Officer.

"We shared a lot of common space in that old office, and we shared a lot of patient strategies," he recalled. "We were noticing that a lot of patients with diabetes not only had periodontal disease, but also had diabetic retinopathy, and vice versa."

Soon, Dr. Dueñas was recognizing signs of periodontal disease during his diabetic eye examinations and referring to his next-door colleague. It wasn't long before the nearby pharmacist followed suit, affixing notices on medication bags that reminded patients of their yearly eye and dental exams.  

Later, podiatry joined the fray, and thus a multidisciplinary network of primary care doctors was born to manage patients with diabetes. The model propelled Dr. Dueñas to a state task force and on to the Centers for Disease Control and Prevention (CDC) where he ultimately became the first full-time doctor of optometry on staff.  

But the model didn't end there. In 1996, the CDC collaborated with the National Diabetes Education Program (NDEP) to form the PPOD (pharmacy, podiatry, optometry and dentistry) frontline care team. A unique bloc of providers that may often be the first to detect a patient's diabetes, PPOD professionals are well positioned to advise and educate patients about diabetes control and prevention.  

"Our goal is to help each provider group understand how they can be proactive in the care of their patients, but also collaboratively work with each other as members of the health care team," Dr. Dueñas says.  

Two decades of success later, the integrated, comprehensive PPOD care model is more relevant than ever and doctors of optometry can find resources to help build and grow their own multidisciplinary network.  

PPOD toolkit: A guide for practitioners  

"No man is an island," wrote John Donne. Although Donne most certainly wasn't referring to diabetes care, the expression offers an uncannily accurate description of modern diabetes care. That's because diabetes care requires an interconnected approach that ensures no one specialty shoulders the load of Americans' diabetes epidemic alone.  

The NDEP's guide, "Working Together to Manage Diabetes: A Toolkit for Pharmacy, Podiatry, Optometry and Dentistry (PPOD)" offers doctors a comprehensive, easy-to-use guide on each specialty and its relation to diabetes. The guide is written for professionals outside of that specialty so all team members who might provide care can collaborate and make cross-disciplinary referrals.  

Inside the PPOD guide doctors will find:  

• An overview of the team care approach to diabetes management
• Tips on communicating with patients
• Specialty-specific sections
• Resources and links to other PPOD-related tools  

"The toolkits provide an understanding of what to look for in terms of early complications of the disease, and how and when to provide the conduit to necessary care," Dr. Dueñas says. "Again, with diabetes everything is about early identification of complications—the earlier you can identity, the easier it is to treat."  

Read the November/December 2016 AOA Focus article, "Eye Care in the Diabetes Age," and access the AOA's first evidence-based clinical practice guideline, Eye Care of the Patient with Diabetes Mellitus.