Sue Kirkman, MD, responds

Timely question!  The American Diabetes Association recently  published the first-ever position statement— a medical guideline—on treatment of type 1 diabetes  in all age groups. Prior position statements have  been limited to specific groups (such as children or  pregnant women with type 1) or specific issues (such  as driving and diabetes or employment discrimination).

What to Know

Medical visits for type 1 have typically focused on the “ABCs” (A1C and blood glucose patterns, blood pressure, cholesterol or cardiovascular risk) and screening for complications of diabetes.  The position statement reminds us to also address emotional health (how diabetes is impacting your daily life), whether you are having low blood glucose (hypoglycemia), and whether you might have other autoimmune problems such as thyroid disease or celiac disease.  Other recommendations include checking on self-management skills (after all, 99 percent of diabetes care is done by you between doctor visits) and figuring out how your provider can best support you in areas  such as exercising and following a healthy diet.

It obviously takes time to assess and discuss all these issues, and fitting it all into a short clinic visit can be a challenge. Preparing ahead  of time for your visit can make it a meaningful experience for you and your health care providers.

Also, the focus on more than just labs and medical issues means  that team care works best for people with type 1. In some clinics, that includes your diabetes doctor as well as certified diabetes educators, registered dietitians, and often others, such as psychologists and exercise physiologists. The team approach extends to “beyond the walls” team members: eye doctors, ob-gyns for women of childbearing years, and your primary care clinician. And, of course, the most important team member is you, the person with diabetes.

Takeaways

For your next diabetes visit, bring a checklist adapted from the type 1 position statement, which you can download at diabetesforecast.org/type1. Knowing what you should expect at  your doctor visits—and speaking out about your needs—is a great  step to take!