Control Diabetes Before It Controls You: How Group Visits Improve Care

In Greek mythology, after escaping his prison, Icarus soared close to the sun, despite his father’s instructions to fly neither too high nor too low. His wings of feathers and wax melted before he plummeted to his death. In modern day, patients with type 2 diabetes similarly seek to escape their symptoms at the doctor’s office, and they receive instructions just as difficult—maintain a level of blood sugar that is neither too high nor too low, or face harsh consequences.

Diabetes affects one in ten Americans and is the seventh leading cause of death in the United States. More than 1 in 4 health care dollars spent in the United States are for people with diabetes, and research predicts one in three people will be living with type 2 diabetes by 2050. A pervasive chronic disease, type 2 diabetes occurs in people whose bodies have cells with “broken” insulin receptors, which are normally responsible for converting sugar to energy. Similar to Icarus who was warned to fly neither too high nor too low, people with type 2 diabetes must monitor the trajectories of their blood sugar to remain at a stable level.

diabetes group visits
Carlo Saraceni’s “The Fall of Icarus”

Blood sugar monitoring requires you to prick your finger with a needle and put a drop of blood on a glucose test strip that is inserted into a glucometer, a device that will display your blood sugar level on its screen. If the resulting number isn’t within a healthy range, you must then adjust your blood sugar: eating food causes blood sugar to rise, while taking injections of insulin lowers blood sugar. Insulin is both an artificial drug and natural hormone found in the body; people with type 2 diabetes inject artificial insulin to override the effects of “broken” insulin receptors and convert blood sugar to energy cells can use.

Blood sugar levels that are too high or too low can cause major complications like amputations or blindness. Such was the case with Philip Rule, a man who was living with diabetes for a decade, and battling foot ulcers from it for more than two years. He underwent 12 surgeries in 30 days before receiving a below-the-knee amputation. “I want to tell [people with diabetes] how important it is to monitor your sugar levels three times a day,” Philip said.

While these monitoring and injecting tasks may seem simple, if you peer into doctor’s offices across the country, you will find a lot of patients with unchecked diabetes. A patient’s ability to meet the challenges of diabetes self-care depends on factors that can go unaddressed by regular appointments, such as cultural needs, emotional concerns, family support, financial status, and health literacy. Blood sugar monitoring can be even more invasive when your doctor does not help you find solutions that are compatible with your culture, your access to certain foods, or your home environment.

To address these gaps, University of Chicago researchers, such as Dr. Arshiya Baig, are studying new models of care called Diabetes Group Visits. Group Visits incorporate group education with one-on-one appointments and provide patients with up to two hours time with health center staff to improve understanding, treatment and satisfaction for patients with type 2 diabetes. For example, “If [Dr. Baig] went around the Mexican communities here and told our Mexican patients to start eating broccoli, they would ask, ‘Uh, where would I get that? And how do I prepare it?’” Dr. Baig said in an interview. “But if you take some of the traditional foods that they are used to eating and that are accessible in their neighborhoods, and work with them to improve the healthy content of that food, then you are making progress.”

University of Chicago researchers are finding that Diabetes Group Visits have profound effects on patients’ lives. Group visits can reduce average blood sugar levels, promote healthy eating habits, and lower the psychological distress of managing diabetes for patients with type 2 diabetes. When people with the same condition are able to sit together to brainstorm self-management techniques, talk about their experiences, and mention what worked for them and what did not, research shows they are more likely to absorb information about their diabetes while also gaining support and accountability.

diabetes group visits
Cheryl Elder, St. Mary's Healthcare System
Certified diabetes educator Cheryl Elder leads a Diabetes Group Visit with patients in Georgia. Taken by St. Mary’s Health Care System.

The integrative care approach of Diabetes Group Visits is also key to its success, as one Group Visit includes many services within one setting, such as a medical exam, a flu shot, blood work, prescription refills along with group education, goal setting and other social support activities. In this way, Diabetes Group Visits address the pitfalls of time constrained one-on-one medical appointments. “We have ample time for education and discussion concerning things like the foot exam, and the eye exam, and carb counting,” said a medical professional in an anonymous survey on the implementation of Group Visits. “In a 15-minute office visit, we don’t have time to do that.”

Dr. Baig argues that health care professionals need to support patients in their home environments. This means that they must educate patients in how to communicate their needs to their family members and also train family members on supportive practices, such as helping inject insulin, planning healthy meals and influencing whether a patient decides to exercise.

Ask your doctor if your health center offers Diabetes Group Visits, and if they don’t, perhaps ask them why. Share this article with a friend who has diabetes and encourage them to seek a better health center if their current one doesn’t help with self-management. The American Association of Diabetes Educators has a list of certified diabetes education programs. Once you find a program near you, make sure to set up an appointment.

Once you have enrolled, sit back and prepare to receive a new form of diabetes care that is affordable, successful and sustainable. Like Icarus, you may look at a clear sky that is open and promising, yet be rest assured that you will not fall.

Sara Siddiqui is an undergraduate at the University of Chicago studying race theory. She is also a poet and a painter working to improve health in minority communities and make medicine more responsive to minority needs.

Sara’s article is part of a collaboration between the Illinois Science Council and the University of Chicago.