Fran Kaufman's Visit To Haiti

LETTER FROM THE MEDTRONIC DIABETES CHIEF MEDICAL OFFICER

MEETING PATIENTS WHERE THEY ARE, WITHOUT UNDERESTIMATING THEM

BY FRANCINE RATNER KAUFMAN, MD

MEETING PATIENTS WHERE THEY ARE, WITHOUT UNDERESTIMATING THEM Achieving diabetes control is a lifelong journey, and every patient who walks through the door of your practice brings a unique set of “baggage”—some of it helpful, and some that you most likely wish could be checked at the door.

As a diabetes educator (DE), getting to know each of your patients means learning more about their literacy/health literacy, comfort with technology, motivation to adhere to lifestyle goals, and dedication to the care plan. While some patients present more challenges than others when it comes to education and training, the DEs/certified product trainers (CPTs) that we work with at Medtronic Diabetes have taught us something important: You need to meet patients where they are, but be sure not to underestimate them—or yourself.

LETTING GO TO LET GOOD THINGS HAPPEN

Meeting patients where they are also may mean letting go of some of our preconceived notions about them. For example, in considering sensor-augmented pump (SAP) therapy for a patient on multiple daily injections (MDI) with difficult-to-control type 2 diabetes, it’s natural to wonder: “Will this patient be able to do the carb-counting necessary to be successful?” or, “Will she test at least 4 times a day?”

What the DEs that we work with across the country have told us time and time again is that even the most challenging patients often surprise them—as long as their care team meets them where they are, and doesn’t underestimate them.

Sure, some workarounds or additional support may be needed—patients who just can’t grasp traditional carb-counting may need to go with a 30-60-90 approach, or those who aren’t testing enough on MDI will need to become more adherent to be successful on pump therapy.

Ultimately, what you may find once patients are on integrated pump therapy is that they have a renewed motivation to succeed—due to having a powerful clinical tool after years of roadblocks, and because someone (you!) believes they can succeed.

EXTRAORDINARY CIRCUMSTANCES, EXTRAORDINARY RESULTS

During the past few years, my husband Neal and I have been fortunate to witness first-hand the positive results that can come from meeting patients with diabetes where they are—and not underestimating them. This life-changing experience has been in the most challenging of circumstances, while taking part in a global advocacy effort in Haiti.

Along with a number of partners (particularly FHADIMAC, Haiti’s national diabetes association), we launched and continue to run the country’s first-ever diabetes camp for children with type 1 diabetes.

Even with minimal treatment, the positive changes we have seen in these children—both clinically and in understanding their disease and how to treat it—have been nothing short of miraculous. Even on the most basic insulin dosing regimens, these kids, many of whom are homeless or living in tents, are getting a new lease on life.

We teach them how to check their blood glucose (BG) levels and why it’s important. For some of the kids, the lights really seem to go on. They start to understand why their BG levels are high and low, and how food and exercise affect their levels. They are able to decide what dose of insulin might work best for them. While some children do not pick up on the education and training as easily, we know that incrementally, they must be benefitting to some degree.

During the closing ceremonies at our camp last year, each child wound a long piece of yarn around him- or herself and passed it across a circle to a fellow camper to symbolize how they are all interlocked. When they spoke about their experience, it was incredibly touching. One child said: “Diabetes is the best thing that happened to me, even though I hate it.”

Another added: “Some people care. I’m not alone.”

And, after all, isn’t that what it’s all about? Your patients also know that you care, that they are not alone—and that you believe in them. You are making a difference.

Editors’ Note: Interested in learning more about Dr. Kaufman’s global advocacy initiatives? Check out her initial trip to Haiti: A Recent Visit to Haiti; her first year volunteering at Haiti’s first-ever diabetes camp (3-part series): Return to Haiti: Part 1, Return to Haiti: Part 2, and Return to Haiti: Part 3; her second year helping out in Haiti (2-part series): Haiti 2013: Diabetes Management and the Magic of Laughing Children and Haiti 2013: Diabetes Management and the Magic of Laughing Children Part 2; third year at the Haiti diabetes camp: Making a Difference in Haiti-Part 1 and Making a Difference in Haiti 2014-Part 2; and her trip bringing insulin pumps to kids in Kazakhstan: Pumping in Kazakhstan – Might Not Be What You Think.

SOURCES
Kaufman F. Making a diabetes difference in Haiti 2014: Part II. Medtronic Diabetes: The LOOP blog. Published May 14, 2015. Accessed May 12, 2015.
FHADIMAC home page. FHADIMAC Organization. Accessed May 12, 2015.
Kaufman F. A recent visit to Haiti. Medtronic Diabetes: The LOOP blog. Published March 24, 2011. Accessed May 12, 2015.
Kaufman F. Making a diabetes difference in Haiti 2014: Part I. Medtronic Diabetes: The LOOP blog. Published May 13, 2014. Accessed May 12, 2015.
Kaufman F. Return to Haiti part 2. Medtronic Diabetes: The LOOP blog. Published March 15, 2012. Accessed May 12, 2015.
Kaufman F. Return to Haiti part 3. Medtronic Diabetes: The LOOP blog. Published March 19, 2012. Accessed May 12, 2015.
Kaufman F. Haiti 2013: Diabetes management and the magic of laughing children. Medtronic Diabetes: The LOOP blog. Published April 10, 2013. Accessed May 12, 2015.
Kaufman F. Haiti 2013: Diabetes management and the magic of laughing children part 2. Medtronic Diabetes: The LOOP blog. Published April 25, 2013. Accessed May 12, 2015.
Kaufman F. Making a diabetes difference in Haiti 2014: Part I. Medtronic Diabetes: The LOOP blog. Accessed May 12, 2015.
Kaufman F. Making a diabetes difference In Haiti 2014: Part II. Medtronic Diabetes: The LOOP blog. Published May 13, 2014. Accessed May 12, 2015.
Kaufman F. Pumping in Kazakhstan: Might not be what you think. Medtronic Diabetes: The LOOP blog. Published October 29, 2012. Accessed May 12, 2015.

Francine Ratner Kaufman, MD, is Chief Medical Officer and VP of Global Clinical, Medical and Health Affairs at Medtronic Diabetes in Northridge, Calif.; a Distinguished Professor Emerita of Pediatrics and Communications at the Keck School of Medicine and the Annenberg School of Communications of the University of Southern California; and an attending physician at Children’s Hospital Los Angeles. Dr. Kaufman has published more than 220 peer-reviewed and invited publications and is the author of more than 40 books or book chapters. In 2012, she authored the Insulin Pump and Glucose Sensor Book for the American Diabetes Association (ADA) and edited the 6th edition of the ADA’s Medical Management of Type 1 Diabetes. In 2005, her book Diabesity was published by Bantam. Dr. Kaufman was chair of the National Institutes of Health-funded Studies to Treat (the TODAY Trial) or Prevent (the HEALTHY Trial) Type 2 Diabetes in Youth (STOPP-T2). Dr. Kaufman has served as president of the American Diabetes Association (2002-03), chair of the National Diabetes Education Program, and chair of the Youth Consultative Section of the International Diabetes Federation. She is a member of the Institute of Medicine and served on the Advisory Council of the NIDDK branch of the NIH. Dr. Kaufman received her Doctorate of Medicine from Chicago Medical School, Chicago, Ill., where she was valedictorian. She completed her internship (Pediatrics), residency (Pediatrics), and fellowship (Pediatric Endocrinology) at Children’s Hospital of Los Angeles, Los Angeles, Calif.