The significance of opening diabetes care clinics

In the past, patients' passive response of "going to the hospital to prescribe antidiabetic drugs when they felt uncomfortable" has been transformed into a proactive health intervention that covers the entire cycle of diet, exercise, medication, and complication monitoring. Ultimately, it can help patients reduce the risk of complications, reduce long-term medical expenses, and improve the quality of life. It can also divert the pressure of routine follow-up visits from specialists and leave high-quality medical resources to critically ill patients who need it more.

I have been a specialist nurse in the endocrinology department of a tertiary hospital for 8 years, and I have seen too many embarrassing cases. The one that impressed me the most was Uncle Zhang, a 62-year-old diabetes patient, who has been suffering from type 2 diabetes for 12 years. Before, every time he came to the endocrinology clinic, he would go straight to the point and prescribe metformin. If the doctor asked him a few more questions, he would leave in a hurry, saying "I don't have any discomfort, just because my blood sugar is high." It wasn't until last winter that his feet were numb for half a month, and he walked like walking on cotton. He couldn't bear it anymore, so he came for a check-up. He already had early-stage diabetic peripheral neuropathy. If it hadn't been discovered in time, he might have developed a foot ulcer in another six months, posing the risk of amputation. If he had come to the diabetes care clinic regularly for follow-up visits two years earlier, and someone would have been watching his blood sugar regularly and adjusting his diet, he would not have been dragged to this point.

In fact, when we first heard that the hospital was going to open a diabetes care clinic, we also had different opinions within us. Some colleagues felt that "it is difficult to get an endocrinologist's appointment, and opening a nursing clinic takes up resources. It is better to push all routine follow-up visits to the community." Some patients did not understand and thought, "What diseases can nurses see?" It only costs a dozen yuan to get a doctor's number, so I can't afford to find a nurse." When we first opened the clinic in 2021, we were overwhelmed with appointments throughout the day. On the worst day, only three patients came.

As a result, after just half a year of running, the data slapped those who questioned it in the face. Before the opening of the clinic, only 37.2% of the patients with diabetes who were followed up in our hospital met the glycated hemoglobin standard. In the first year after the opening of the clinic, it rose to 49.6%. At the end of last year, statistics reached 58.9%. Moreover, our number sources were separately drawn and did not account for the doctor's quota at all. Doctors are freed from the repetitive work of "prescribing conventional medicines to old patients and answering questions about how to measure blood sugar", leaving time for patients with difficult initial diagnoses and serious complications. Last year, the per capita rate of doctors in our endocrinology department receiving severe patients increased by 21% compared with before the opening of nursing clinics.

Many people think that diabetes care clinics are just about testing blood sugar and talking about popular science. This is not true. Last month, a 28-year-old Internet programmer came here. He had just been diagnosed with type 2 diabetes. He squatted at the door of the clinic with the report and cried, saying that he was not married yet and would suffer from uremia or amputation in the future. Our specialist nurse organized a small group for him, helped him calculate his daily carbohydrate intake while working overtime, and taught him how to choose a salad without stepping on the trap of "hidden sugar".

Of course, diabetes care outpatient models vary across regions, and there is no so-called “standard answer.” Some places adopt the path of integrating medicine and prevention. Specialist nurses go to the community two days a week to teach and train community nurses on how to adjust the basal insulin dose and how to identify early signs of diabetic foot. This is equivalent to extending the services of the nursing clinic to the doorsteps of patients. ； There are also places that engage in Internet + nursing. The blood glucose data measured by patients at home are transmitted to the backend in real time. When nurses see abnormalities, they take the initiative to call for follow-up, eliminating the need for patients to go to the hospital. However, there are also objections, saying that “Internet follow-up is not as reliable as face-to-face consultations and can easily miss diagnoses.” Our experience is that as long as hierarchical management is done well, patients with mild and stable conditions can be followed up online, and patients with fluctuating conditions can be scheduled for face-to-face consultations at any time, which is much more efficient than crowding into the hospital.

There are also many people with diabetes who are calculating small accounts and think, "nursing clinics also charge registration fees. Can't I test my blood sugar at home?" ”, we also understand that charging standards are different in different regions. The registration fee for diabetes care clinic here is 15 yuan, and we can also use medical insurance co-ordination, which is not much different from the cost of buying test strips at home. We did statistics last year and found that patients who insisted on following up in the nursing clinic for a full year had 0.7 fewer hospitalizations per year than those who did not follow up, and the per capita annual medical expenses were nearly 4,000 yuan less. If you really end up in the hospital because of complications due to no one to guide you in adjusting medications or eating indiscriminately, the money you spend in one time is enough to stay in the nursing clinic for decades.

In fact, at the end of the day, we as nurses deal with patients with diabetes every day and know their difficulties best: fear of high blood sugar if they eat too much, fear of hypoglycemia if they eat too little, fear of pain when taking insulin, and fear of side effects when taking hypoglycemic drugs. Many problems cannot be solved by a doctor's prescription. The existence of the Diabetes Care Clinic, to put it bluntly, is to provide people with diabetes with a "managed" platform. They don't have to rush to get expert accounts every time something happens. If you have any small questions, you can always find professional people to ask. Nowadays, many places are organizing public welfare follow-up groups and free science popularization lectures, just to lower the threshold a little further. No matter how the model changes, the greatest significance of opening this clinic is to help people with diabetes avoid complications and spend less money.