Diabetes
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Diabetes Resources
Diabetes is a complex chronic disease that is difficult for providers to fully master which makes it that much more difficult for patients. A patient plan of care has been provided to act as a provider checklist and to help your patients understand and take control of their diabetes. Also available are Power Points on comprehensive diabetes care, diabetes medications, insulin management, glucose logs and educational posters and videos for providers and patients. Using a combination of these tools will help the care be successful and lead to less “non-compliant” labeling of patients.
Point of care labs
The current prevalence of diabetes has made point of care testing essential for diagnosis, management and monitoring of patients. No all point of care testing is the same. There are two validated machines for A1c, the DCA Vantage and Afinion meet the ADA requirements. The cost of each test is around $7.
The National Association of Free Clinics has multiple partners each year to sponsor establishing point of care labs through Heart to Heart International in clinics that include but are not limited to A1c, CMP, lipids and microalbumin which would cover all of the laboratory based quality metrics for treating patients with diabetes.
Medications
Medications for diabetes can be costly and usually the $4 list and resources like GoodRx are not helpful when looking for medications other than metformin. You do not have to resort to using sulfonylureas and 70/30. Each pharmaceutical company (i.e. Sanofi, Novo Nordisk, Eli Lily) has a patient assistance program that can provide free or discounted medications to patients who are uninsured or whose insurance will not cover insulins, GLP-1, DPP4 inhibitors and SGLT2 inhibitors. A simple search on NeedyMeds should provide all the information needed, reference the Medications page of the Resource Index for best practices getting patient assistance medications. Once approved, patients will receive a years worth of medication. The prescription needs to be for 3 months with 3 refills. If you are having trouble with the process watch the video provided on the Medications page of the Resource Index.
DME
Many pharmacies are now carrying low cost diabetes DME. If your patient needs to monitor their glucose levels at home there are a number of meters that are cheap, the key is to make sure the strips are cheap as well. Patients should not have to pay more than $10 for their meter and $10 for a box of 50 strips. The Walmart Relion brand has always been a cheap reliable brand and now there are a number of other pharmacies and online vendors that have similar products. Lancing devices and a box of 100 lancets can be purchased at any pharmacy for under $5 as well as sharps containers. The Relion brand syringes and pen needles can also be purchased for under $10 as well at Walmart, and like the other DME is likely available at a number of other pharmacies and online vendors that have similar products. Glucose logs can be purchased on-line or made by your organization. Available in the links is a personalizable glucose log to your clinic and your patients. Respecting patient autonomy and logging sugars based on medical necessity are key to patients filling the log out correctly. There are a couple examples of logs for patients who are on basal insulin or basal bolus insulin. If patients are not on insulin there is little utility to having them check their sugars.
Diabetic Retinopathy Screening
If you do not have a resource available to provide diabetic eye exams for your patients they can be referred to St. Vincent de Paul’s medical clinic. The clinic has an Eidon retinal scanner that does not require the patient to be dilated and takes clear photos that can be imported to your EHR. They also have volunteer optometrists, ophthalmologists and retinal specialists who can treat certain conditions if necessary. If you work for an FQHC or a local charity clinic see if your organization has the process set up with St. Vincent de Paul, otherwise feel free to contact the clinic at medical@svdpaz.org to inquire about setting up these services for your patients. There are benefits to being able to screen for DMR in your own clinic and there are a number of retinal cameras/scanners available if your clinic would prefer to perform this as opposed to referring out.