Dr. Jeanne Rosenthal, MD
Attending Surgeon of Retinal Service at the New York Eye and Ear Infirmary
Board Member of Diabetes Self-Management
POINT OF VIEW
Creating better education for diabetes patients
We had the pleasure of speaking with Dr. Jeanne Rosenthal, who, as Attending Surgeon of Retinal Service at the New York Eye And Ear Infirmary, is at the forefront of working with patients who are first diagnosed with diabetes. Her insight into the need for increased patient education, especially at the beginning of a new patient’s change in lifestyle, sheds light on how important creating better adherence programs can be for the diabetes landscape at large.
What makes you most excited about your role on the board of Diabetes Self-Management?
Diabetes Self-Management helps encourage patients to take care of their own health, and get as much information as they can. I think it’s very empowering.
A major current issue surrounding the health care industry is of diabetics developing health issues because they are unable to stay with their required protocol. What to you see as the most effective potential solution to solving the problem?
I think there’s a lot of diabetic education not being done. I think education is really the key to have patients truly understand what they should be doing, and then it’s a question of positive reinforcement. Asking them every time how they’re doing, how their blood sugar is and how they are doing with their diet. We’re so busy talking to patients who aren’t doing what they need to be doing we are missing giving positive reinforcement to those that are doing well, which creates something of a negative cycle.
Do you have some lines of advice for health care providers?
That’s really the big point. Doctors don’t have enough time to talk to patients and it’s really a shame. Diabetics need a lot of time spent educating, and doctors don’t have enough time. It’s a terrible thing, so education is really a necessity. It just doesn’t work to see a patient and not take the time to talk.
Here’s an example. I saw a patient in a clinic. She was a lady who didn’t have a very long education, but she was not stupid. She had been diagnosed recently, but didn’t have anything wrong with her eyes. She was motivated to take care of herself.
Six months later I saw her and she was drinking from a quart of orange juice. She was so proud because she had given up soda, and was drinking natural products. I had to tell her that it had as much sugar as soda. I realized that her entire education up to that point consisted of a 1-page paper with some points on it. I told her she needed to see a diabetes specialist to design a diet that she can live with. She’s somebody whose doctor spent 5 minutes with her and didn’t give her the education she needs, and she’s extremely motivated. I stepped in as her eye doctor, and told her she needed someone else to help her.
Patients need to realize that if their insurance companies cannot do for them, they need to be able to find help on their own.
What do you think is the best time for an adherence program to be administered to most effectively keep patients adhering to their necessary protocol?
Right when they are diagnosed. We have to start with their education right then. They need to understand the chemistry of how their bodies break down sugar. Even if they are in good shape, they need to be on a healthy lifestyle program. You can’t get away with not doing it for a while. You have to do it right away.
What topics would you like to specifically be able to address in terms of cultivating better patient adherence in the near future?
Follow up. The support of a group might help, or the support of an individual. I think it’s different for all people. It’s similar to weight loss. One thing that helps one person might not motivate another. A group may not motivate every person, because they do better with a personalized nutritionist. People have to find something that works for them.
What trends have you seen occurring recently with your patients within the diabetes community?
The big trend of course is the insulin pump. The patients on the pump tend to do really well. They have better control of their sugar. They also tend to be more gadget-oriented, and number-oriented. People who enjoy fine-tuning their blood sugar get a lot out of it. Overall they get positive reinforcement from the pump as well.
What do you think about the concept of the Fit4D Pathways as a tool to help create better patient adherence?
I think it’s a great idea. A main problem I notice is dealing with patients at such varied levels. Some patients don’t know anything about science, so talking about blood sugar and hemoglobin makes no sense to them. Others are more educated, so being able to talk to them at different levels and within different pathways is a very good idea.
It’s very rigorous to change an entire lifestyle. It’s extremely difficult to adjust to not being able to take a day off from staying on such a strict diet and lifestyle.
What news do you want to share right now with the diabetes patient community?
If you really do all this stuff, it’s definitely worth it. It sure beats the alternative, which is a horror. It’s difficult but it’s worth it. All studies are showing that long-term stability is achievable. It just takes a certain amount of effort, but the effort it completely worth it.