November 14th is World Diabetes Day and this year’s theme is “Access to Diabetes Care.” For individuals living with diabetes, whether newly diagnosed or experienced in the journey, access to specialized care in Northwestern Ontario is available. There are two large diabetes education centres in Thunder Bay (Centre for Complex Diabetes Care and Diabetes Health), and many clinics have government funded services on site.
Both the Centre for Complex Diabetes Care (CCDC) and Diabetes Health have registered nurses and dietitians offering assessments and self-management education. Glycemic monitoring has evolved, with remote data sharing and sensor-based scanning devices, instead of capillary blood glucose testing (“finger poking”). This means improved data sharing, more convenient and less painful self-monitoring. As well, counselling professionals for both programs offer support and facilitate coping related to diabetes burnout, stress, emotional eating and other mental health barriers.
Diabetes Health invites self-referral for patients with established pre-diabetes or diabetes to receive individual or group education. Medication changes occur by the primary care provider. This centre uniquely offers intensive programing for paediatric, insulin pumps and maternity populations in an evolving field of technological and biomedical advancements.
Unlike Diabetes Health’s invitation to self-refer and long-term maintenance support, the CCDC requires physician or nurse practitioners referral to offer intensive case management for up to one year. Team composition differs from Diabetes Health by including two nurse practitioners, a pharmacist, an Indigenous liaison, an occupational therapist, and foot care/chiropody services. There is a specialized support team composed of a psychologist and social worker to address barriers overshadowing diabetes self-management.
CCDC nurse practitioners fill a gap in specialized services, particularly for those living with diabetes without a primary care provider without access to routine care. Services include advanced assessment, diagnosis, ordering and interpreting lab tests and diagnostic imaging, prescribing medication, and referral to specialists when indicated. Key areas of focus are establishing blood glucose targets and vascular management (cholesterol, blood pressure, kidney health, smoking cessation), as well as monitoring for complications (eye, nerve, kidney, feet, erectile dysfunction, peripheral vascular disease, heart, peripheral vascular disease, stroke). With the many advancements in medications over the past four years, patients can access treatments with demonstrated improved outcomes related to glycemic control, cardiovascular and renal protection in specific populations. Between nurse practitioner visits, follow up is provided by the interdisciplinary team depending on needs for support and education.
Individuals with interest in these programs should seek primary care services (family physician, nurse practitioner, walk-in clinic) to provide assessment, screening, or referral for those eligible. Diabetes Canada publishes full guidelines, and each chapter includes key messages to people living with diabetes. To learn more, visit https://guidelines.diabetes.ca/.