Perspectives on Diabetes Care

The Role of Diabetes Care and Education Specialist in Co-Conditions and Diabetes-Related Complications

Apr 30, 2021, 07:00 AM

By Anne M. Misher, PharmD, MBA, BCACP, BC-ADM, CDCES

Recently it has been estimated that 98% of adults with type 2 diabetes have one co-condition and 89% have at least two comorbidities. These conditions and complications can create significant burdens on the individual, the diabetes care team and the healthcare system.

Persistent hyperglycemia contributes to a host of microvascular or macrovascular complications including atherosclerotic cardiovascular disease, retinopathy, nephropathy and various neuropathies. Beyond these diabetes-related complications, people with diabetes face a wide range of co-conditions including obesity, hypertension, periodontal disease, liver disease and depression; just to name a few. 

The diabetes care and education specialist has vast knowledge when it comes to assisting people with diabetes and co-conditions or complications. They have specialized training to collaborate with interprofessional teams to optimize care for people with diabetes. Skills include:

• Facilitating necessary referrals to diabetes self-management education and support (DSMES) and medical nutrition therapy (MNT).
• Promoting risk reduction strategies.
• Recommending treatments.
• Partnering with the person with diabetes to provide ongoing education and shared decision-making support.  

Cardiometabolic Disease 

The scope of the diabetes care and education specialist has expanded with the increase in efforts to identify and treat people with prediabetes and diabetes. They should utilize the ADCES7 Self-Care Behaviors™ framework to incorporate cardiovascular considerations into diabetes self-management education and support. Furthermore, they should advocate for routine cardiovascular risk assessments and, in collaboration with the person with diabetes and care team, facilitate the management of modifiable risk factors and treatment of abnormal cardiovascular screenings or clinical findings according to current guidelines.  

Microvascular Complications 

The diabetes care and education specialist should educate individuals about complications including retinopathy, kidney disease, autonomic neuropathy and peripheral neuropathy. They can provide clients information regarding the importance of and strong recommendation for screenings and referral to specialists when appropriate. Additionally, they are able to provide social support and access to social work when people with diabetes need additional resources related to these complications. Many diabetes care and education specialists can provide recommendations for dose adjustments or discontinuation of medication to optimize therapy regimens. 

Oral Health 

A number of oral manifestations have been associated with diabetes. The diabetes care and education specialist can screen for oral issues, educate about oral health and self-care, advise of periodontal risk, and facilitate preventive care and treatment referrals to oral healthcare professionals. Additionally, they can collaborate with oral health professionals who conduct diabetes screenings to develop referral algorithms. 

Liver Disease 

Liver disease is a co-condition experienced by some people with diabetes. The diabetes care and education specialist can assist with various lifestyle changes as well as assistance with weight loss through DSMES and MNT. 

Mental Health 

Depression and diabetes distress are two common mental health conditions in persons with diabetes. Diabetes care and education specialists should assess signs and symptoms of diabetes distress, depression, anxiety, eating disorders and cognitive abilities related to management using standardized and validated tools. Furthermore, they should consider initiating referrals to mental health specialists when necessary.  

Complications and chronic co-conditions are common among people with diabetes. However, the diabetes care and education specialist is well-positioned to be an integral member of the interprofessional team that optimizes care through recommended screenings, risk reduction, therapy optimization and education for those with diabetes. Access new guidance and resources from ADCES at DiabetesEducator.org/CoConditions.