Diabetes Screening in the Wound Clinic: Reader Survey Results

  Last month, Today’s Wound Clinic featured a comprehensive series of articles related to the management of diabetes within the wound clinic — from clinical issues such as the cardiovascular effects of diabetic foot ulcers to the importance that wound clinic providers should recognize in conducting routine glucose screening and education on nutrition and other disease-management concerns. This month, as part of our special focus on best practices, we present our readers with the results of an anonymous survey we conducted by polling our readers (your peers) about how well wound clinics may or may not be providing screening and following up on their patients’ diabetes management after discharge. More than 140 wound care clinicians participated in the survey, which produced some surprising and intriguing results.

Diabetic Screening: Not A Given?

  Despite the high prevalence that diabetes plays in wound centers across the US, 69.5% of survey respondents said they do not screen those patients who are living with chronic wounds for the possible presence of undisclosed diabetes (Figure 1). Likewise, an even greater majority (77.1%) doesn’t screen all patients known to be living with the disease for comorbid clinical depression (Figure 2), even though those who are diabetic have a greater chance of developing depression. (However, most in this patient population are said to not be living with this comorbidity, according to the American Diabetes Association.)   Still, what is the wound clinic’s responsibility to screen for the presence of these conditions? According to Caroline Fife, MD, FAAFP, CWS, medical director of St. Luke’s Wound Clinic, The Woodlands, TX, and editorial board member of TWC, “these are the questions you need to ask in your clinic because if you don’t know the answers, you’re not involved enough in the patient’s care.”   Despite these numbers, most wound clinics are at least tackling the issue of compliance among the diabetes population, according to this survey, as 87.3% report assessing adherence to overall diabetes management through screening (Figure 3). Still, finger-sticking for blood glucose checks does not appear to be one of the predominant screening measures. Only 30.6% of respondents report checking patients’ blood glucose at each visit (Figure 4) while others claim to do so only when symptomatic (15.3%; Figure 4) or only during initial visits (4.2%; Figure 4) or even randomly (7.6%; Figure 4).   Despite these low numbers, the advantages of glucose finger-sticking have been proven affective when integrated into daily protocol, according to Tere Sigler, PT, CWS, CLT-LANA, clinical director of the Archbold Center for Wound Management at Archbold Memorial Hospital, Thomasville, GA.¹ When it comes to checking hemoglobin A1c on all chronic, nonhealing wound patients, the numbers are better, with 58% responding affirmatively (Figure 8).

Availability of Certified Diabetes Educator

  While the opportunity to be proactive and comprehensive when it comes to screening wound care patients and following up with them and their providers as they move along the care continuum may individually be determined on the initiative of each clinic, financial and administrative obstacles may play a part when it comes to providing patients with a certified diabetes educator (CDE).   According to 64.6% of survey respondents, their clinics do not feature the services of a dedicated CDE or dietitian, while only 17.4% can offer the advantages of having both on staff (Figure 5). However, 67.2% of those without a dietitian and/or diabetes educator report making referrals for patients to visit one or both (Figure 6). This may be encouraging, but on the flipside are the 33.1% of wound care providers among survey respondents who do not support these referrals with distribution of their own educational materials (Figure 7). According to Sigler, who is also a member of the TWC editorial board, wound clinic staff should be diligent in their diabetes education distribution whether or not they employ a CDE.    “We (as wound care providers) need to conduct diabetes education in our clinics because of the repetitiveness in which we see these patients,” she said. “That means you don’t have to get someone to process all the information at once. The wound clinic is a great setting to provide diabetes education, but the reality is that it’s not everyone’s first priority. And when things get busy the education part can fall off the radar.”

References

1. Sigler, T. Monitoring blood glucose values in the wound clinic: An aggressive approach to diabetes management. Today’s Wound Clinic. 2013;7(2):18-19.