Aug. 3, 2023 -- It’s easy to get overwhelmed with information when you’re newly diagnosed with type 2 diabetes. Diabetes is a chronic condition and often self-managed, so questions naturally come up over time as well.
So how do you make the most of communicating with your doctor during a 15- to 30-minute office visit?
WebMD asked three diabetes experts for advice. In the following Q&A, they address how people can best prepare for an office visit, how to be your own advocate, and what other resources to turn to if you need more help.
Do your homework, make every minute count, and ask questions: These are the first three of six tips offered by Elizabeth Holt, MD, head of global medical, clinical, and safety at LifeScan Inc., a diabetes device and app company. Interrupt your doctor if necessary, be 100% honest, and leverage your whole diabetes team: Those are the additional strategies recommended by Holt, who has 28 years of experience as an endocrinologist.
“If they don't ask the questions that need to be asked, it doesn't help them, and it doesn't help their health care providers,” Holt said. “If you don’t truly understand, then you're not going to get the most benefit out of your appointment.”
Read on for a look at more expert tips.
Q: What advice do you have for people to get their diabetes questions answered when they meet with their doctor?
Holt: Being prepared when you go into your appointments is important. Learn about diabetes ahead of time so you have the basic information. It's more important to spend the limited time that you have getting into more specifics tailored to you and how you can better manage your diabetes.
Akshay B. Jain, MD, clinical instructor, Department of Endocrinology, University of British Columbia, Vancouver, Canada: When I’m going to see a patient, I've reviewed their labs and I have a spiel in my head of what I’m going to talk about. But that may not line up with the patient’s priorities. Doctors see patients every few months, so it's really important that patients be their strongest advocate, ask questions, and talk about their challenges at every visit.
Anne Peters, MD, director, Clinical Diabetes Programs, University of Southern California, Los Angeles: I always start with ‘How are things?’ question because I want to know about the person before I know about the medical condition. It really helps if people write their questions down in advance so they can look at them on their phone or hand them to me.
I recommend patients say, ‘I have some questions. Can I ask them now or should I wait?’ Because the thing that gets the hardest for me is when patients are too shy and they ask me their list of questions when the visit is already done, or at least done in my mind.
Q: What if a patient comes in with a list of more questions than can be answered during one office visit?
Holt: The most important thing is to identify your top two or three questions to make sure you get to them first. You can always schedule a follow-up appointment or ask others on your health care management team -- a nurse, diabetes educator, or a dietitian.
Jain: A list can be a good thing and a bad thing. A list helps people remember what they want to talk about. But having a long list may not lead to a good doctor patient interaction. So say, ‘These are my top priorities.’
Peters: If a patient has questions, they can hand to me or send them to me in advance. Then I can go through them and triage the questions, I might say, ‘This is a good question, but you need to ask your primary care doctor.’ Or ‘Let's focus on diabetes at this visit and the next visit will focus on whatever else is on the list.’ Sometimes I ask them to choose the three most pressing things they want to discuss.
Q: Has the growing number of people diagnosed with diabetes affected the amount of time people and providers have to interact?
Holt: Doctors have more patients to see but not any more time. Time is such a valuable resource. Do what you can do to learn about your health care ahead of time and to understand your diagnosis.
Jain: Oftentimes, when diabetes is diagnosed, it doesn't come alone. Diabetes is a chronic metabolic disorder associated with other conditions like obesity, overweight, or hypertension. All of those now come to the forefront at the doctor's appointment and addressing them takes time.
Peters: Because time is limited, I might suggest people attend a diabetes education class, talk to a diabetes educator, or meet with the dietitian. In an ideal world, there are resources like this available to all people with diabetes. A lot of times I get questions about food or carbs. I like to acknowledge the question and say, "That's a great question. I'm glad you're thinking of it but let's have you talk to the dietitian."
Q: If people do research ahead of time, there is Dr. Google, artificial intelligence, and a lot of other information online. How does someone know they're getting reputable information?
Holt: A very important way is to ask your doctor or your health care team what sites they recommend. A good place to start would be the American Diabetes Association. The American Association of Clinical Endocrinology also has patient information.
Jain: There's a lot of information, and trying to segregate the garbage from the reliable sources can be difficult. So go to trusted websites like the Mayo Clinic website for patient education. If you Google questions, take the answers with a pinch of salt. Often the information is not applicable to everyone with diabetes.
Peters: My feeling is that lots of people who are wildly successful or doing horribly post on the internet. So you may not get the average person with diabetes -- you're going to get the extremes. When somebody asks me, I tell them what sites I recommend, like the ADA, the Juvenile Diabetes Research Foundation, or the CDC site on Diabetes Basics.
Q: There are a lot of direct-to-consumer ads online and on TV. Do this help answer questions or raise awareness?
Holt: I think that's an opportunity. It helps you think of important questions to ask your doctor. If you see A1c come across the TV screen and you don't know what your A1c is or what an A1c means, it's certainly a springboard.
Jain: That creates awareness for sure. If there's something that frequently pops up on TV or other media, then patients are more likely to ask about it.
Peters: It's helpful. It gets a conversation going. I don't think it teaches people anything, but they do help in my mind so people know and can ask about different options.
Q: There's a lot more attention on certain diabetes drugs now, like the GLP-1 agonists Ozempic, Rybelsus, Trulicity, and others. Does this also help with awareness?
Holt: If talking about those medications elevates the conversation, then I’m all for it. Those are important treatments that are now available. Focusing attention on diabetes and destigmatizing it also is very important. It helps people be more open with their diagnosis and more willing to take their medications and monitor their blood glucose in public.
Jain: It is a double-edged sword. When people hear about these medications, they've already kind of made up their mind. They hear about people having really good weight changes or improvement in their health and they automatically assume that this is the medication for them. Or the converse, they might read this one report of one person having this horrible side effect and they automatically assume that this happens to every person that goes on the medication. It’s important to have that discussion with your doctor about what is right for you.
Peters: Sometimes the ads make it look like ‘just take this and everything will be perfect’ and that's not true. The GLP-1 receptor agonist class has been on the market since the exenatide approval in 2005. So those of us in this field are very used to using these drugs and they cause weight loss, and the newer ones cause more weight loss. But I want that to make sure that everybody realizes that all medications have side effects -- and it’s always about risk versus benefit.
Q: Is there anything else I haven't asked that you think would be helpful to patients?
Holt: I think it's important for patients to know that they need to be empowered to take care of their diabetes. Don’t be afraid to ask questions to understand your diabetes, all the things that impact it, and how to manage it. You need to be able to measure the impacts by monitoring your glucose so you can better manage your diabetes.
Jain: A chronic condition like diabetes requires a lot of nurture and ongoing care. It's really important that there be open communication that is not judgmental between the patient and the doctor.
Peters: Ask your doctor to screen for diabetes. The ADA lowered the screening age to 35 years in 2022 and recommend all adults with overweight or obesity and at least one risk factor for type 2 diabetes get their blood glucose tested. To be a true self-advocate, people need to know what their fasting glucose is. If they have pre-diabetes, they can work on prevention. And once they had diabetes, they need to treat it so they’re going to be healthy. They can end up doing great. My patients, in general, do really well and that is in part because they ask the questions.
