THE MICHIGAN COLLABORATIVE FOR TYPE 2 DIABETES

• Patient satisfaction with their diabetes care experience.
• Patient exposure to recommendations like low-carb eating, referrals to dietary counseling, access to diabetes education, CGMs, and newer diabetes medications.
• Patients sense of confidence in their diabetes management and sense of support from their primary care team.

Key Takeaways from Practices

Generally High Patient Satisfaction and Confidence

• Practices noted overall high patient satisfaction with their diabetes care, communication, and decision-making.
• Many patients expressed confidence in managing their type 2 diabetes, often attributing this to support from their care team.
• Patients appreciate the interventions, tools, and resources offered and generally feel well-supported and involved in their care.

Low Participation in Diabetes Self Management Education and Support (DSMES) and Formalized Low Carb Diet Support

• Increasing DSMES referrals is seen as an opportunity.

"Diabetes education is not as accessible to many patients in rural areas, and leadership is working on ways to improve the program." —Sleeping Bear Dunes Region Practice (Northern Michigan)

• Practices acknowledged the recurring need for more education on diabetes management for both patients and providers.

"We need to offer more diabetes education and discussions regarding CGM." —Sleeping Bear Dunes Region Practice (Northern Michigan)

• Many patients are informed about low-carb diets, but referrals to dietitians and formal education classes are less frequent.

"While a low carbohydrate eating pattern was recommended to all of the patients who took the survey...less than half were offered referral to a registered dietitian. Also, the number of patients who have participated in DSMES was very low, with the majority stating they are not interested." —Grey Wolf Region Practice (Kalamazoo area)

• Some respondents noted the importance of ongoing education and providing resources to understand and manage their condition better.

"Most people are only moderately confident in managing their diabetes. This is something we need to work on." —Sleeping Bear Dunes Region Practice (Northern Michigan)

"Patients need to have more information regarding their diabetes. They need to know what the next steps are and when to follow up with their next appts and HbA1c." —Blue Jay Region Practice (Livonia area)

Increasing Prescribing of CGMs through Improved Operational Workflows

• Practices recognize that there is consultation on the use of CGM, but it’s not consistently offered to all patients.
• Some practices indicated a need to improve the process around recommending and implementing CGMs.
• CGM is seen as beneficial for managing type 2 diabetes, but uptake and knowledge could be improved.

"Only 20% of our patients have had a CGM ordered for them, and we feel like this is because the CGM process can be confusing for our physicians." —Badger region practice (Ann Arbor region)

Taking Time to Strengthen Provider-Patient Communication and Understanding

• Effective communication and listening were critical for improving patient confidence, satisfaction, and trust.

"It's also clear that when patients feel trust in their care team, they are more likely to have better outcomes." —Badger region practice (Ann Arbor region)

• Practice representatives want to encourage providers to spend more time ensuring patients understand their diagnosis and treatment options.

Room for Improvement in Referrals and Team-Based Care

• Practices acknowledged successes while pointing out opportunities for improvement in care offerings and patient education.
• Programs paused during the pandemic should be considered for a restart, as well as improving educational resources.

"We used to offer in house classes on diabetes education and when covid happened we stopped doing these classes in our office (and our certified diabetes educator NP retired). We would be open to restarting these classes if MCT2D offered educational resources" —Black Bear region practice (Troy area)

• Discussions on improving organizational processes to better support diabetes management, such as increasing referrals to the diabetes education department and the involvement of case managers.

Strength in Collaboration and Team-Based Care

• Success is noted in collaborative efforts and utilizing multidisciplinary teams, including pharmacists and dieticians, to manage patient care.

"We have a robust care management team and from the feedback, it appears that this is instrumental in providing all of the follow up information to the patients that the providers can't possibly cover in a visit. Our approach is very collaborative and based on the feedback...effective. Thank you for providing this information to us." —Badger region practice (Ann Arbor region)

• Some clinics report high effectiveness of collaborative approaches in improving patient outcomes.

Areas for Practice Improvement

1. Improve Education and Resources

• Emphasis on improving patient and staff education on diabetes management, diet, and CGM use.

"I would like to have more educational material in my practice about the disease itself with pictures so it's easy to understand." —Black Bear region practice (Troy area)

• Develop and distribute more educational materials, including handouts on low-carb diets, information on DSMES classes, and resources for managing diabetes.

"We plan to come up with ways to spark patients' interest in DSMES, such as creating a poster for the office." —Grey Wolf Region Practice (Kalamazoo area)

• Care managers should be used to provide ongoing education and support for patients with diabetes.
• Focus on making diabetes education resources more visible and accessible to patients.

2. Utilization of Continuous Glucose Monitors (CGMs)

• Encourage and educate providers about CGM usage and benefits, and provide training in navigating insurance coverage for these devices.

“We are going to work on improving our process on how to order CGM's and help our physicians with this." —Badger region practice (Ann Arbor region)

• Address barriers to CGM approval and coverage; work to increase prescribing of CGMs when appropriate.

"We found some of the barriers for more patients utilizing CGMs were the out-of-pocket costs, especially if they have commercial insurance." —Riverwalk Pier region practice (Saginaw area)

3. Increase Referrals to Diabetes Education and Support

• Plan to refer more patients to registered dietitians, DSMES classes, and self-management support programs.
• Consider implementing more creative ways to engage patients in diabetes education and support, including addressing cost and accessibility issues.

4. Diet and Lifestyle Modifications

• Strengthen conversations around diet, exercise, and lifestyle changes during patient visits.
• Include more referrals to dietitians and educators for personalized nutrition and exercise plans.

"We will... arrange a meet and greet with the dietitian, so providers are aware of who they are and what services they have to offer." —Grey Wolf Region Practice (Kalamazoo area)

5. Patient Follow-Up and Monitoring

• Improve follow-up processes, ensure regular monitoring of blood sugar levels, and maintain contact with patients who miss appointments.

"Work with staff, making sure that the patients keep their appointments. If they cancel or no show, call them and make sure they get on the schedule as soon as possible." —Riverwalk Pier region practice (Saginaw area)

• Encourage patients to attend follow-up visits and stick to treatment plans to achieve their A1c goals.

6. Shared Decision-Making and Patient Involvement

• Foster patient involvement in decision-making processes to enhance their commitment to managing diabetes.

"Some of our patients still do not feel confident managing their diabetes care, so we will continue to work one-on-one with patients to determine individual treatment plans." —Sleeping Bear Dunes Region Practice (Northern Michigan)

• Use motivational interviewing and other resources to empower patients.

7. Addressing Medication Management and Accessibility

• Improve understanding of medication use and address insurance and cost barriers that limit access to medications and devices.
• Ensure patients receive proper guidance on managing their medications effectively.

8. Collaborative and Proactive Approach

• Encourage a team approach that includes regular discussions with care managers and integrating community resources.

"Have the patient meet with the care manager in the office following visits with the provider to discuss diabetes and provide education packets." —Bluegill region practice (Grand Rapids area)

• Focus on proactive and personalized patient care, building trust and support for patients with diabetes.

"We feel we can improve on asking patients how they feel about their diabetes management more often to really figure out how we can support them on a more individual basis." —Bluegill region practice (Grand Rapids area)

9. Addressing Social Determinants of Health

• Enhance technology integration and address broader social factors that impact diabetes management.
• Improving access to services.

"We also plan to make DSMES more accessible to patients with transportation concerns by bringing a diabetes educator to the office monthly." —Grey Wolf Region Practice (Kalamazoo area).