Talk Diabetes 2018 was an education event presented by The Diabetes Education and Management Centre of Kingston Health Sciences Centre – Hotel Dieu Site on May 11, 2018. It was a day packed with many valuable contents to be shared among health care professionals looking for an updates in diabetes, especially with the recent release of the 2018 Diabetes Canada Clinical Practice Guidelines. Here are some notes I took:
Cathy Crowe RN – It takes a home.
The event began with a talk by Cathy Crowe who described the importance of community resources to help address the homeless situation in our community. She went on to encourage each of us to do more to address the situation…. because without a home, we cannot attain health. I have to admit her talk was very inspiring and it made me a little emotional and my heart sank when I saw images of homeless people on the street. She encourages us to reach out to support and advocate for a national housing strategy.
Robin Witzke and Madison McIntosh – Diabetes and Homelessness: Challenges and Solutions to Stabilization
This next talk discusses some of the challenges in managing diabetes for the homeless population. A lot of the challenges relate to the ability to accessing health care in the first place. Homeless people are less likely to have a valid health card on hand (e.g. belongings are often stolen multiple times while living on the street) – so it may take awhile to collect the appropriate documentations to replace their health card to access medical care. Also, they are less likely able to access and afford healthy food, or willing to pay for medications when the money may be needed to buy immediate food to deal with hunger. They also may not have a refrigerator for insulin storage. In terms of booking for medical appointment, they may not be able to keep an appointment several weeks down the road (e.g. do not have a day planner or a smartphone). Their priorities may be different too. If they are looking for place to stay today and just got an offer to stay at a friend, this will take priority over the appointment at 2pm with the physician. As health care providers, we should be more sensitive to these challenges so we can adapt the way we deliver care to meet their needs.
Dr Martin Feakins – Psychiatric medication, psychiatric disorders and diabetes: a community psychiatrist’s approach
The next talk by Dr. Martin Feakins focused on how to look after patients with diabetes and psychiatric disorders. Patients with diabetes may often have psychiatric disorders. Not only would the concurrent conditions impact on treatment decision (e.g. selecting antipsychotic with less potential for weight gain), it also affects the ability to engage patient for optimal diabetes control (e.g. patients with psychiatric disorders may have poor compliance with medical interventions). He highlighted that the key is not to focus on what we cannot attain (e.g. not making progress with glycemic control) but to also remind ourselves that we as health care providers as a team are likely helping to prevent the patient from further health decline as well. Focus on things we can improve.
Dr Feakins also highlighted which antipsychotics have the highest relationship with weight gain, risk of Type 2 diabetes and worsening lipid profile:
Below are some of his Take Home messages:
Shelley Brant RN & Jodi John RD – Letting down your professional guard: building relationships with Indigenous clients
This was another powerful presentation in which many pearls of wisdom were shared. The presenters highlighted how indigenous clients may have different expectations in a relationship, that sometimes there is mistrust or miscommunication due to difference in cultural values and beliefs. Indigenous clients enjoy connecting and building personal relationships and seeing the human side of us before trusting us with their care. We need to keep this in mind and let our professional guard down to build trust. This may involve seeing the patients more frequently (e.g. not every 3 months) to discuss things that may not be related to their diabetes. But once they know they can trust you, they will be receptive to more diabetes education and know to how seek you out when they need attention with their medical care.
Dr John Puxty – Challenges and Conundrums in care of the Fail Diabetic Senior with Multiple Chronic Diseases
Dr. Puxty highlighted the importance of assessing frailty in the elderly population with diabetes. This can be done using the Clinical Frailty Scale. There are three main reasons why understanding the frailty is important:
- It can be predictive of long term outcomes (e.g. estimate years of survival)
- It may be reversible (e.g. frailty may be reversed with increased mobilization and social support)
- It may guide prescribing and care decision (e.g. determine benefits and risks of starting statin / BP medications that may require longer time to gain benefits)
The last talk was on the Update on the 2018 Diabetes Canada Clinical Practice Guidelines by Dr. Robyn Houlden. This will require a separate blog post to summarize the notes. Stay tuned for Part II of Talk Diabetes 2018.