clinical topic updates

Multidisciplinary Care for Patients With Type 2 Diabetes

by Rita Rastogi Kalyani, MD, MHS, FACP

Overview

A deeper understanding of comorbidities in type 2 diabetes that go beyond the traditional microvascular and macrovascular complications has placed multidisciplinary care in the spotlight, underscoring the importance of coordinated care.

Expert Commentary

Rita Rastogi Kalyani, MD, MHS, FACP

Editor in Chief, Johns Hopkins Diabetes Guides
Director, Diabetes Management Service
Johns Hopkins Total Pancreatectomy Islet Auto Transplant Program
Associate Professor of Medicine
Johns Hopkins University School of Medicine
Baltimore, MD

“ . . . to provide optimal care for patients with type 2 diabetes, we need to actively work together to promote and enhance the multidisciplinary care system.”

Rita Rastogi Kalyani, MD, MHS, FACP

Multidisciplinary care is critical for patients with type 2 diabetes. It has long been accepted that nutrition, diabetes education, and a comprehensive care team (including the health care provider, dietitian, and nurse educator) are integral to type 2 diabetes self-management at home. More recently, multidisciplinary care systems have begun to recognize the importance of including providers from different specialties, particularly because many specialties aside from endocrinologists (eg, nephrologists, cardiologists, and primary care physicians) are now prescribing glucose-lowering therapies for cardiovascular and/or renal protection.

We now have a better understanding of the various comorbidities, beyond the traditional microvascular and macrovascular complications, that occur in patients with type 2 diabetes. This has established multidisciplinary care as one of the focal points of optimally managing type 2 diabetes. For example, some of the newer glucose-lowering therapies have the added benefit of reducing the risk of certain comorbidities, such as cardiovascular disease, chronic kidney disease, and heart failure. In addition, bariatric surgeons play an important role in treating patients with type 2 diabetes who are also obese, a common type 2 diabetes comorbidity. Surgery improves not only a patient’s weight management but also their glycemic control, highlighting the importance of collaboration across specialties.

Multidisciplinary care is also important due to the frequency with which type 2 diabetes is recognized by clinicians outside of the diabetes specialty. For instance, a dentist may see an infection in a patient with diabetes and may subsequently refer them to their diabetes care specialist for further management. So, the diabetes care specialist may not necessarily be the first medical professional whom a patient sees.

For this vital multidisciplinary care system to function smoothly, clear, consistent communication between diabetes care specialists and other members of the health care team is critical—and this is where we still need a better understanding of the optimal coordination model, as we are increasingly recognizing the importance of comprehensive care for patients with type 2 diabetes. We also must ensure that the patient is not overburdened or overwhelmed with the various specialists they may be seeing. Therefore, to provide optimal care for patients with type 2 diabetes, we need to actively work together to promote and enhance the multidisciplinary care system.

References

Abdulrhim S, Sankaralingam S, Ibrahim MIM, et al. Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service. BMC Health Serv Res. 2021;21(1):192. doi:10.1186/s12913-021-06183-z

American Diabetes Association. Summary of revisions: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(suppl 1):S4-S6. doi:10.2337/dc21-Srev

Conca T, Saint-Pierre C, Herskovic V, et al. Multidisciplinary collaboration in the treatment of patients with type 2 diabetes in primary care: analysis using process mining. J Med Internet Res. 2018;20(4):e127. doi:10.2196/jmir.8884

Hamdy O, Ashrafzadeh S, Mottalib A. Weight management in patients with type 2 diabetes: a multidisciplinary real-world approach. Curr Diab Rep. 2018;18(9):66. doi:10.1007/s11892-018-1030-4

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