Ask a Provider: Diabetes
Michelle Johnson, MD
Adult and Family Medicine
Whittier Street Health Center runs a Diabetes Clinic and is accredited by the American Diabetes Association as a Center of Excellence for Diabetes Self-Management.
Dr. Michelle Johnson has worked at Whittier since 2003. Her clinical interests are women’s health and cardiovascular disease. In this post, she talks about her experience with helping patients manage their diabetes.
1. How has diabetes affected your patients over the years?
A large number of Whittier patients have been diagnosed either with type-2 diabetes or pre-diabetes. It’s one of the most common chronic diseases that we see here at the health center.
We prescribe insulin therapy and diabetes pills, if necessary. But there are many cases where diabetes also comes with a diagnosis of hypertension or heart disease, so we have to be careful when prescribing medication so we can protect the patient’s liver.
(Note: Because of the high rates of hypertension and heart disease that present with diabetes, Whittier also offers case management support to diabetic patients through the Connections for Cardiovascular Health Program funded by the AstraZeneca HealthCare Foundation.)
2. What kind of work did you do with patients in the Diabetes Clinic?
The Diabetes Clinic is a group visit model for about six diabetic patients and their primary care team. It usually starts with a presentation by one of the providers. The topic is tailored to the needs and interests of the group. For example, one session will focus on the foods that can help with the condition, and another session could be a discussion about how to gradually increase physical activity and fitness.
Afterwards, the patients have time for one-on-one sessions with their physician, Nutritionist, or the Certified Diabetes Educator (CDE). They use this time to discuss individuals concerns.
3. How effective is the Diabetes Clinic?
I think it’s very effective. For one thing, patients have access to the entire team—the doctor, the nutritionist, and the CDE. So they could speak to each one during a visit, and that’s an efficient use of everyone’s time. A lot of topics can be covered in one session, or maybe just one topic in depth that the group is particularly interested in.
For another, the peer support component of the groups helps patients teach each other about methods for managing their condition. They can talk about what worked for them, and how it might work for others. And it helps reinforce the idea that they’re not alone, that other people are going through the same thing.
4. Are other providers involved in helping patients manage diabetes?
Yes, we have a Podiatrist who does feet exams, and patients get care for glaucoma in the Eye Care Department.
Outside of the group visits, our Nutritionist does field trips to grocery stores to teach healthy shopping on a limited budget, and she does cooking demonstrations in our kitchen.
5. What kind of self-management goals do patients have?
Patients with diabetes have a lot of self-management goals that they work on together with their health care team. They could be: to reduce carbohydrates intake, or to eat less sugary foods. Exercise is a big one. A lot of patients try to exercise more, because that’s a proven way to help manage diabetes and prevent the onset of complications.
6. November is American Diabetes Month. What advice would you give individuals or families who are struggling with or are at risk for diabetes?
I recommend that they come in for a screening if they have a family history of diabetes, or if they’re concerned because they might be overweight. Getting screened in time can help prevent or delay the onset of type-2 diabetes.
It’s also important to catch the symptoms early so we can work with the patient to avoid the typical complications of diabetes, such as kidney disease and blindness.
There’s a lot we can do to fight diabetes. Whittier has been doing it a long time, and I think we do a good job.
Whittier Street Health Center offers the Diabetes Clinic through its Adult Medicine Department. Please call 617-989-3115 for an appointment, or schedule a visit through our website.