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The Importance of a Team Approach to Diabetes Care
Diabetes is a complex disease that can affect many parts of the body and your life. It is important to take a team approach to care for yourself. Not only do you have to be involved in your own care, your health care providers need to work together to offer comprehensive coordinated care. Learn from Dr. Kashif Munir, a Diabetes expert at the University of Maryland Medical Center – Midtown Campus, what to consider and how to get the care you need.
Featured Speaker:
He helped establish a multidisciplinary pituitary practice at the Center and currently sees patients for diabetes, thyroid disease, pituitary and adrenal disorders. Dr. Munir also has active research protocols for pituitary and thyroid diseases, and works with Dr. Michael Quon in studying the effects of food polyphenols on insulin resistance and endothelial dysfunction.
Kashif Munir, MD
Kashif Munir, MD, is an Assistant Professor of Medicine at the University of Maryland School of Medicine, in the Division of Endocrinology, Diabetes and Nutrition. He joined the University of Maryland faculty in 2011, and has extensive clinical experience in treating complex diabetes patients, thyroid disorders, and pituitary diseases.He helped establish a multidisciplinary pituitary practice at the Center and currently sees patients for diabetes, thyroid disease, pituitary and adrenal disorders. Dr. Munir also has active research protocols for pituitary and thyroid diseases, and works with Dr. Michael Quon in studying the effects of food polyphenols on insulin resistance and endothelial dysfunction.
Transcription:
The Importance of a Team Approach to Diabetes Care
Scott Webb: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
This episode is sponsored by the University of Maryland Center for Diabetes and Endocrinology. Nationally recognized by the Committee for Quality Assurance for Expert Diabetes Care, the University of Maryland Center for Diabetes and Endocrinology provides diagnosis, treatment and long-term care for children and adults living with type 1 and type 2 diabetes and endocrine disorders. Located on the University of Maryland Medical Center's Midtown campus, the Center for Diabetes and Endocrinology includes a comprehensive team of physicians, nurses, dieticians, and diabetes educators working collectively to evaluate and determine the best treatment plan for each patient.
And I'm joined today by Dr. Kashif Munir. He's an Associate Professor of Medicine, Division of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine. I'm Scott Webb. Doctor, it's so great to have your time today. We're going to talk about diabetes and the team approach. But before we get rolling here, maybe just as a baseline for listeners, maybe you can go through what is diabetes and specifically what's the difference between type 1 and type 2 diabetes.
Dr. Kashif Munir: Yeah. So diabetes, it's a very common disorder as most people probably know. And it's a disorder of your blood sugar where, you know, your blood sugar levels are elevated. And now we know there are many types of diabetes. The main two that we categorize are type 1 and type 2, like you mentioned. Type 1 diabetes is much less common. It's maybe 5% to 10% of all diabetes in the United States. And that is where your pancreas stops making insulin, most often due to an autoimmune process. So your immune system basically attacks the cells in the pancreas, which make insulin, and slowly they become less functional. And so patients with type 1 diabetes require insulin to manage their blood sugars.
Type 2 is much more common, 90 to 95% of all diabetes can be categorized into type 2. And that is often in people that are usually older, sometimes also overweight. And that often can be managed with medications, oral medications, pills. And eventually, a lot of patients with type 2 also require insulin, but that can be after many years.
Now we know that people that are younger can also get type 2 or not overweight, so there is some variability, but in general, that's kind of how they're categorized.
Scott Webb: Yeah. So as you say, type 2 is much more common. And our focus today is really about people with diabetes, when they should see their doctors, a team approach to, you know, treating folks with diabetes. So let's get into that now. How often should people with diabetes see their doctors?
Dr. Kashif Munir: So typically, we'll see patients with diabetes at least every three months. Again, that's kind of an average and we can see them more often if their sugars are uncontrolled. But if they're doing really well, then sometimes we'll only see them every six months or even once a year. But in general, it's every three months.
And one of the main reasons is one of the tests we use called hemoglobin A1c, it's a longer term average of your glucose control. And we've found in many studies that hemoglobin A1c levels really correlates well with complications. So if your hemoglobin A1c is high, there's a higher risk of complications. And if it's well controlled, there's a lower risk of complications. And that test kind of gives us a two- to three-month average of your blood sugar levels. And so that's why we like to see people every three months, so we can kind of get an updated long-term average of their glucose control and make sure that the sugars are in target range. And if they're not, we can make changes, so that, you know, we can help patients get to that target.
Scott Webb: Yeah. And I'm wondering, you know, with the advent and popularity of smart devices and, you know, people having wearable technology and being able to connect with their phones, does the daily monitoring, the daily testing, the use of these smart devices also help patients and doctors?
Dr. Kashif Munir: Yeah. For sure. I think that's a great point. The classic glucometer that we had, where you would stick your finger and get blood, I think that's still the most common monitoring device, but even that connects now with phones and so we can share data and patients have real-time access to how their sugars are doing.
But with some of the newer devices where we have what we called continuous glucose monitors, so they give us much more updated information and much more information on a daily basis. So some of these devices measure your sugar every one to five minutes. And so you can tell what your sugar is at all times of day, all times of night, how they do after you eat certain foods, how they respond to exercise and so on. So I think with that feedback, patients have a lot more information and can, you know, adjust their lifestyle so that they know that their sugar levels are being better controlled.
Scott Webb: Yeah, for sure. You know, you mentioned earlier that weight is related especially to type 2 or generally related. What other health conditions are related to diabetes?
Dr. Kashif Munir: Yes, diabetes really has a potential effect on many parts of the body and that's why it is one of those chronic diseases that we really try to manage aggressively so that, you know, we're not running into these complications. So the way we think about diabetes complications, it really affects blood vessels. And so it can affect big blood vessels, like those going into the heart or to your legs or to your brain. And ultimately, there are complications that can occur, like heart attacks or strokes or what we call peripheral arterial disease. And then it can also affect smaller blood vessels like those in the back of the eye or in the kidney or the ones going to the nerve endings and so that can cause different complications such as vision loss or kidney disease, chronic kidney disease and what we call neuropathy, so patients can sometimes get numbness or pain in their feet and sometimes this can lead to not feeling things when you step on them and ulceration and complications with your limbs and ultimately sometimes amputation even.
So it is, you know, a condition that's associated with a lot of different organ systems and has a lot of potential complications. The good news is that if we do control things well, we really can lower those risks significantly. And so, you know, a lot of it is controlling the blood sugar, but we also realized diabetes is a syndrome. And so things like blood pressure and cholesterol levels are also very important. And since diabetes does affect blood vessels and blood pressure and cholesterol also can affect blood vessels, we really target all of these together. And so when you see a diabetes doctor, you're going to get help with your sugar control, but we'll also be looking at your blood pressure, looking at your cholesterol and making sure we're managing all the risk factors so that we can really minimize any risk long-term.
Scott Webb: Yeah. And you mentioned that it's a syndrome and there's a lot of concerns beyond just blood sugar. So when we think about the team approach from primary through diabetes doctors, you know, why is it important for providers to coordinate that care for diabetes patients?
Dr. Kashif Munir: Yeah. So a lot of our patients do have some of these complications. And so that's why we really find it important to have coordinated specialized care. So for example, in our diabetes center, the kidney doctors actually come into the same space. And so since that's one of the common coexisting complications, we can coordinate and work with them so that they can manage and help specialize in management of the kidney disease while we work on the blood sugar control and blood pressure and so on.
We also work closely with the heart doctors, the cardiologists. We work closely with the wound center. We work closely with the vascular doctors. We also know diabetes is associated with something called fatty liver disease. So some of our patients end up having liver issues. So it's really a condition that affects so many different parts of the body and so many different specialists may need to get involved.
So our goal is to really provide that coordinated care, so you have expertise in all of these areas as you need it. And some people with diabetes don't have any of these complications. So I don't want to scare everyone, but it's one of those things that, you know, if you need the care, we have the specialist to kind of help manage that part of it. And then we work together as a team to make sure that all the different areas are being addressed to the best ability that we can.
And we work with the patients too. And then we also have diabetes educators, so we have nutritionists and nurses that can help with some of this technology that you mentioned and help people get started on that. And then, to use it more effectively, we can actually download all of that data when, you know, patients come in and some of that we can actually even do from home. So as you stated, if a patient notices that their glucose levels might be running a little bit high or low or a little off, sometimes we can share that data right online and we can look at it and help address that even from the patient's home.
Scott Webb: Yeah, it's really amazing that you can see and download and share that information, you know, virtually in real time, which, you know, just speaks to the importance of these smart devices and the internet and all these things that we all love so much.
Dr. Kashif Munir: Yeah.
Scott Webb: And you mentioned the team approach. And as we wrap up here, doctor, for those who need it, as you said not everybody needs it, but for those who need it, you probably really recommend that team approach. And maybe you could just go over the many advantages, not only to patients, but also to their team.
Dr. Kashif Munir: Yeah. So I think, you know, a lot of this is communication and a lot of it is education. So I think the team approach really helps with that part of it. So, like I was saying, if somebody has other coexisting diseases or complications from diabetes, we feel like taking that team approach so that patients are getting the best care to address each of those issues.
And then as providers, I think, as you mentioned as well, it's great because we can communicate. You know, a lot of these specialties are co-located in the same location. And then we share our electronic records so we can communicate electronically as well and it really helps keep everybody on the same page. So for example, the kidney doctors may address blood pressure, but we may address it too, a heart doctor may address it too. So sometimes you have a lot of different people that have some overlapping expertise.
And if people are doing it without coordination and communication, you might run into a problem. And I've seen it before where patients are on multiple medications, which may be in the same class and so they really shouldn't be taking these things together, or somebody just made a change in one of their medications and then somebody makes almost like an opposite change. So if you don't have that communication, you can actually run into more side effects or complications from some of this management. So that's why I think the team approach really helps, that everybody's on the same page and they're really working with a patient to make sure that they're getting the best possible care.
Scott Webb: Yeah. As always, with the best docs, it always comes back to, you know, the best patient care. And I don't have diabetes, but if I did, you know, I think I would definitely want that team approach. I would want everybody communicating with each other, downloading information in real time and making sure that I was getting the best care possible. And it sounds like patients are with you and your team. So doctor, thanks so much for your time today and you stay well.
Dr. Kashif Munir: Thank you.
Scott Webb: Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
The Importance of a Team Approach to Diabetes Care
Scott Webb: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
This episode is sponsored by the University of Maryland Center for Diabetes and Endocrinology. Nationally recognized by the Committee for Quality Assurance for Expert Diabetes Care, the University of Maryland Center for Diabetes and Endocrinology provides diagnosis, treatment and long-term care for children and adults living with type 1 and type 2 diabetes and endocrine disorders. Located on the University of Maryland Medical Center's Midtown campus, the Center for Diabetes and Endocrinology includes a comprehensive team of physicians, nurses, dieticians, and diabetes educators working collectively to evaluate and determine the best treatment plan for each patient.
And I'm joined today by Dr. Kashif Munir. He's an Associate Professor of Medicine, Division of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine. I'm Scott Webb. Doctor, it's so great to have your time today. We're going to talk about diabetes and the team approach. But before we get rolling here, maybe just as a baseline for listeners, maybe you can go through what is diabetes and specifically what's the difference between type 1 and type 2 diabetes.
Dr. Kashif Munir: Yeah. So diabetes, it's a very common disorder as most people probably know. And it's a disorder of your blood sugar where, you know, your blood sugar levels are elevated. And now we know there are many types of diabetes. The main two that we categorize are type 1 and type 2, like you mentioned. Type 1 diabetes is much less common. It's maybe 5% to 10% of all diabetes in the United States. And that is where your pancreas stops making insulin, most often due to an autoimmune process. So your immune system basically attacks the cells in the pancreas, which make insulin, and slowly they become less functional. And so patients with type 1 diabetes require insulin to manage their blood sugars.
Type 2 is much more common, 90 to 95% of all diabetes can be categorized into type 2. And that is often in people that are usually older, sometimes also overweight. And that often can be managed with medications, oral medications, pills. And eventually, a lot of patients with type 2 also require insulin, but that can be after many years.
Now we know that people that are younger can also get type 2 or not overweight, so there is some variability, but in general, that's kind of how they're categorized.
Scott Webb: Yeah. So as you say, type 2 is much more common. And our focus today is really about people with diabetes, when they should see their doctors, a team approach to, you know, treating folks with diabetes. So let's get into that now. How often should people with diabetes see their doctors?
Dr. Kashif Munir: So typically, we'll see patients with diabetes at least every three months. Again, that's kind of an average and we can see them more often if their sugars are uncontrolled. But if they're doing really well, then sometimes we'll only see them every six months or even once a year. But in general, it's every three months.
And one of the main reasons is one of the tests we use called hemoglobin A1c, it's a longer term average of your glucose control. And we've found in many studies that hemoglobin A1c levels really correlates well with complications. So if your hemoglobin A1c is high, there's a higher risk of complications. And if it's well controlled, there's a lower risk of complications. And that test kind of gives us a two- to three-month average of your blood sugar levels. And so that's why we like to see people every three months, so we can kind of get an updated long-term average of their glucose control and make sure that the sugars are in target range. And if they're not, we can make changes, so that, you know, we can help patients get to that target.
Scott Webb: Yeah. And I'm wondering, you know, with the advent and popularity of smart devices and, you know, people having wearable technology and being able to connect with their phones, does the daily monitoring, the daily testing, the use of these smart devices also help patients and doctors?
Dr. Kashif Munir: Yeah. For sure. I think that's a great point. The classic glucometer that we had, where you would stick your finger and get blood, I think that's still the most common monitoring device, but even that connects now with phones and so we can share data and patients have real-time access to how their sugars are doing.
But with some of the newer devices where we have what we called continuous glucose monitors, so they give us much more updated information and much more information on a daily basis. So some of these devices measure your sugar every one to five minutes. And so you can tell what your sugar is at all times of day, all times of night, how they do after you eat certain foods, how they respond to exercise and so on. So I think with that feedback, patients have a lot more information and can, you know, adjust their lifestyle so that they know that their sugar levels are being better controlled.
Scott Webb: Yeah, for sure. You know, you mentioned earlier that weight is related especially to type 2 or generally related. What other health conditions are related to diabetes?
Dr. Kashif Munir: Yes, diabetes really has a potential effect on many parts of the body and that's why it is one of those chronic diseases that we really try to manage aggressively so that, you know, we're not running into these complications. So the way we think about diabetes complications, it really affects blood vessels. And so it can affect big blood vessels, like those going into the heart or to your legs or to your brain. And ultimately, there are complications that can occur, like heart attacks or strokes or what we call peripheral arterial disease. And then it can also affect smaller blood vessels like those in the back of the eye or in the kidney or the ones going to the nerve endings and so that can cause different complications such as vision loss or kidney disease, chronic kidney disease and what we call neuropathy, so patients can sometimes get numbness or pain in their feet and sometimes this can lead to not feeling things when you step on them and ulceration and complications with your limbs and ultimately sometimes amputation even.
So it is, you know, a condition that's associated with a lot of different organ systems and has a lot of potential complications. The good news is that if we do control things well, we really can lower those risks significantly. And so, you know, a lot of it is controlling the blood sugar, but we also realized diabetes is a syndrome. And so things like blood pressure and cholesterol levels are also very important. And since diabetes does affect blood vessels and blood pressure and cholesterol also can affect blood vessels, we really target all of these together. And so when you see a diabetes doctor, you're going to get help with your sugar control, but we'll also be looking at your blood pressure, looking at your cholesterol and making sure we're managing all the risk factors so that we can really minimize any risk long-term.
Scott Webb: Yeah. And you mentioned that it's a syndrome and there's a lot of concerns beyond just blood sugar. So when we think about the team approach from primary through diabetes doctors, you know, why is it important for providers to coordinate that care for diabetes patients?
Dr. Kashif Munir: Yeah. So a lot of our patients do have some of these complications. And so that's why we really find it important to have coordinated specialized care. So for example, in our diabetes center, the kidney doctors actually come into the same space. And so since that's one of the common coexisting complications, we can coordinate and work with them so that they can manage and help specialize in management of the kidney disease while we work on the blood sugar control and blood pressure and so on.
We also work closely with the heart doctors, the cardiologists. We work closely with the wound center. We work closely with the vascular doctors. We also know diabetes is associated with something called fatty liver disease. So some of our patients end up having liver issues. So it's really a condition that affects so many different parts of the body and so many different specialists may need to get involved.
So our goal is to really provide that coordinated care, so you have expertise in all of these areas as you need it. And some people with diabetes don't have any of these complications. So I don't want to scare everyone, but it's one of those things that, you know, if you need the care, we have the specialist to kind of help manage that part of it. And then we work together as a team to make sure that all the different areas are being addressed to the best ability that we can.
And we work with the patients too. And then we also have diabetes educators, so we have nutritionists and nurses that can help with some of this technology that you mentioned and help people get started on that. And then, to use it more effectively, we can actually download all of that data when, you know, patients come in and some of that we can actually even do from home. So as you stated, if a patient notices that their glucose levels might be running a little bit high or low or a little off, sometimes we can share that data right online and we can look at it and help address that even from the patient's home.
Scott Webb: Yeah, it's really amazing that you can see and download and share that information, you know, virtually in real time, which, you know, just speaks to the importance of these smart devices and the internet and all these things that we all love so much.
Dr. Kashif Munir: Yeah.
Scott Webb: And you mentioned the team approach. And as we wrap up here, doctor, for those who need it, as you said not everybody needs it, but for those who need it, you probably really recommend that team approach. And maybe you could just go over the many advantages, not only to patients, but also to their team.
Dr. Kashif Munir: Yeah. So I think, you know, a lot of this is communication and a lot of it is education. So I think the team approach really helps with that part of it. So, like I was saying, if somebody has other coexisting diseases or complications from diabetes, we feel like taking that team approach so that patients are getting the best care to address each of those issues.
And then as providers, I think, as you mentioned as well, it's great because we can communicate. You know, a lot of these specialties are co-located in the same location. And then we share our electronic records so we can communicate electronically as well and it really helps keep everybody on the same page. So for example, the kidney doctors may address blood pressure, but we may address it too, a heart doctor may address it too. So sometimes you have a lot of different people that have some overlapping expertise.
And if people are doing it without coordination and communication, you might run into a problem. And I've seen it before where patients are on multiple medications, which may be in the same class and so they really shouldn't be taking these things together, or somebody just made a change in one of their medications and then somebody makes almost like an opposite change. So if you don't have that communication, you can actually run into more side effects or complications from some of this management. So that's why I think the team approach really helps, that everybody's on the same page and they're really working with a patient to make sure that they're getting the best possible care.
Scott Webb: Yeah. As always, with the best docs, it always comes back to, you know, the best patient care. And I don't have diabetes, but if I did, you know, I think I would definitely want that team approach. I would want everybody communicating with each other, downloading information in real time and making sure that I was getting the best care possible. And it sounds like patients are with you and your team. So doctor, thanks so much for your time today and you stay well.
Dr. Kashif Munir: Thank you.
Scott Webb: Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.