Because of online and telephonic education, Bill and Cindy Pepperman, of Linden, have been able to learn ways of managing diabetes even in the midst of the COVID-19 pandemic — something not all people with diabetes are able to do. Geisinger’s own research shows many people are unaware of their risk for developing type 2 diabetes. The hospital has found a drop of about 11% in preventive diabetic care for Geisinger Health Plan members, and they are creating ways to reverse that trend.

Several problems contribute to this drop, including a hesitancy to attend routine, in-person medical appointments.

“Many individuals are afraid to go out in the community,” said Michelle Passaretti, RN, senior director of health at Geisinger Steele Institute for Health Innovation. “They’re not keeping their preventative appointments as scheduled.”

Along with that is food insecurity, which could be a lack of fresh, nutritious food in grocery stores due to COVID-19 disruptions or the inability to pay for healthier food, especially with so many incomes being affected by the virus. Food insecurity and diabetes are bidirectional, Passaretti said. As one worsens, so does the other.

“We’ve seen during this pandemic some of those healthy, nutritious food choices, or lack thereof in our local grocery stores,” Passaretti said. “So with the scarcity of that healthy, nutritious food, folks are not taking as much of a vested interest in minding their diabetes, sometimes for reasons beyond their control.”

With the pandemic affecting incomes and the availability of some food, it’s understandable when people rely on cheaper foods like Ramen noodles, she said, which at 10 packs for $10 can essentially provide a $1-meal, though not the healthiest choice.

Michael Adler, MD, FACE (Fellow of the American College of Endocrinology), at Endocrinology of Evangelical, pointed to problems that especially affect individuals in the Susquehanna Valley, including access to or an understanding of online forms of communication, particularly among rural or elderly populations. Additionally, with more medical personnel filling in gaps at hospitals where high numbers of COVID patients require so much care, it becomes more difficult to find staff members with enough time to train newly diagnosed patients to manage their diabetes.

“Providers have had to adapt,” Adler said, mentioning phone and internet appointments.

On top of all these problems is the stress everyone experiences with a virus that researchers are still studying and trying to understand.

“All this feeds into complicating diabetes,” Adler said. “It’s like throwing gasoline on the fire when people are not taking care of themselves.”

Solutions

To combat some of these problems, Endocrinology of Evangelical offers more telephone and, when practical, telemedicine visits, Adler said. He also recruits other staff members to do some of the basic diabetes education, and he takes advantage of medical companies that offer educational services. The emphasis is always on patient health.

“We’re helping people as best we can to get through this challenging time,” he said. “We tell people, this pandemic is eventually going to pass. But what you do with your health now will impact you years and decades from now.”

Geisinger has found ways to bring care to patients who can’t or don’t feel comfortable meeting in person, including telemedicine visits and other strategies.

“We can send kits to patients to enable them to complete their HbA1c testing in their own home and mail the kits back,” Passaretti said. “We’ve also, through our Fresh Food Farmacy, been able to do a few different, creative ideas.”

Geisinger’s Fresh Food Farmacies in Shamokin, Scranton and Lewistown give low-cost access to the healthy, nutritious food that is especially necessary for managing type 2 diabetes. During the pandemic, Geisinger has also added a porch delivery service for patients with transportation needs who are enrolled in the Food Farmacy program. The hospital also offers contact-free, drive-through programs where food is placed in the trunk of an individual’s vehicle.

Geisinger sometimes takes advantage of these programs to offer drive-thru flu clinics and blood pressure screenings, allowing “some high level but preventative service in the comfort of their vehicle to limit any exposures both for patients and staff, to ensure that level of safety,” Passaretti said.

Bill and Cindy have been pleased with a Diabetes Prevention Program they began attending in January. When the pandemic shuttered most social gatherings, the classes switched to telephone conference calls, which still enabled the couple to learn ways to change to a healthier lifestyle that has resulted in lower weights and improved health for both of them.

Several approaches can alleviate the cost of diabetes medications. Because of COVID’s effects, medical companies are making some drugs more affordable.

“Sometimes we can give patients a sample medicine that can bridge them until we can get them enrolled in a patient assistance program,” Adler said.

“One of the barriers is the cost of medication,” Passaretti said, “so we’ve made insulin incredibly affordable to our patients. The last thing they need to worry about is the cost of their medication. So they can put those dollars toward nutritious food items.”

Geisinger health insurance also offers medicine advantage plans that can help individuals save money on prescription costs.

Diabetes complicates other illnesses

People with diabetes need to be vigilant about their medications. Even on days when they’re not feeling well, they have to maintain their diet, keep hydrated and monitor their blood sugar.

“In diabetes, one of the things we teach people is ‘sick day management,’ trying to educate them on what to do when they’re not feeling well,” Adler said. “If things are not where they need to be, that’s why you have a health care provider you can call. We want our patients to know we’re concerned, and we want to know of any concerns or needs they may have.”

Individuals with high blood sugar, or hyperglycemia, who contract COVID-19 are at risk for worse outcomes. They will probably be a target population for the COVID-19 vaccine.

“People ask me, should I take it?” Adler said. “I say, if you don’t take it, I’ll be happy to take your dose and give it to somebody else. If it’s FDA-approved.”

He recommends all people get an FDA-approved COVID vaccine as soon as it becomes available.

“To me, it’s our greatest hope of getting out of this virus,” he said.

Adler also cautioned against waiting too long to seek medical help, especially for people battling diabetes and COVID-19 at the same time. Hospitals are using tested precautions to keep patients safe. Anyone needing medical care should not put it off.

“I think the most important thing is to give people hope,” Adler said. “We’re going to make it through this. It’s important not to give up.”

Passaretti agreed.

“I think it’s important to know we’re in this together,” she said. “There are always resources to help patients work through some of their fears and anxieties, especially if it relates to the unknown.”

Cindy O. Herman lives in Snyder County. Email comments to her at CindyOHerman@gmail.com

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