Monitoring for nephropathy is an important diabetes care measure

Dr. Barbara Gurden and medical assistant Tabitha Wintermute

Treating diabetic patients means constant monitoring and education to manage their conditions.

For one HEDIS measure in particular, monitoring for nephropathy, Barbara Gurden, M.D., makes it a priority at her Laingsburg practice to test diabetic patients at every visit. She also schedules follow-up visits every three to six months, depending on whether the patient’s diabetes is under control or whether the patient has co-morbidities.

To make sure every diabetic patient is tested for nephropathy, Dr. Gurden works with her quality team and ensures that patients make their follow-up appointments before they leave the office.

“If a patient fails to make the appointment, the receptionist lets me know and we send the patient a message to reschedule,” says Dr. Gurden.

“We also work with our quality team to review lists of patients who have either missed an appointment or missed the nephropathy measure. We’re constantly going through lists of our diabetic patients. You need to be consistent.”

She also credits her medical assistant with making sure all diabetics get their microalbumin tests. The assistant has been working for her 14 of her 20 years in practice.

It’s important to constantly watch both GFR and micro albumin to detect nephropathy, says Dr. Gurden. “I’ll refer to a nephrologist if I start seeing the patient’s GFR levels dropping. I had a patient this year whose GFR decreased quite a bit so I referred her to a specialist. She had a kidney tumor and ended up having surgery. She’s now doing well. We do a lot of coordination with nephrologists because patients will sometimes listen more to a specialist. You need to have a team of pros. It’s too hard to do it by yourself.”

Patient education is also integral to helping patients stay on top of their diabetes and manage their condition. “At the diabetic visit, we also discuss blood pressure, eye exams and why it’s important to check their feet. It’s not just one thing we look at.”

Part of educating patients about the risks associated with diabetes means helping them understand that they need to keep their blood pressure under control, as well as their sugar. “We also tell them to be careful with nonsteroidal anti-inflammatory drugs, or NSAIDs, which can cause a lot of kidney damage,” says Dr. Gurden. The office also advises patients about adequate hydration and nutrition.

For all diabetic patients, Dr. Gurden makes sure patients are compliant with medication.

“We watch prescription refills and receive notifications from the pharmacy. If someone is non-compliant, we call those patients and our staff will review their medications.”

“I also let patients know I’m diabetic,” says Dr. Gurden. “It helps them to know that I have to experience everything they experience.”

Dr. Gurden says there are challenges associated with treating diabetic patients, and those diagnosed with nephropathy.

“For some diabetic patients, a diagnosis of nephropathy becomes a wake-up call for them. They’re getting into chronic morbidity issues associated with diabetes.”

For others, it’s difficult to make lifestyle changes, she says. “One of my patients is morbidly obese, and it doesn’t matter what I say to her or what specialists I send her to. We’ve worked with two endocrinologists and she’s not been able to control her diabetes for a number of years. It’s heartbreaking. I’ve referred her to a nephrologist in the hopes of preventing further damage.”

Dr. Gurden continues to work with the patient to count carbohydrates and discuss diet. “It doesn’t help to get mad,” she says. “You have to keep talking to patients to help change their habits.”