3 ways medicine can partner with public health to prevent diabetes

Timothy M. Smith , Contributing News Writer

Long before she became a physician, Bonnie Coyle Ronco, MD, was keenly aware of how lifestyle choices can affect one’s health. Growing up in a working-class part of Pennsylvania, she spotted a curious trend among her family members: Many were getting sick and dying young from diabetes and heart disease.

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“Something just clicked in my brain that it had to do with the fact that they were overweight, that they weren’t eating well, and that some of them were smokers,” said Dr. Coyle, a preventive medicine and lifestyle medicine specialist, and medical director at the Mecklenburg County Health Department in North Carolina.

Her curiosity soon grew into a calling, and after majoring in nutrition in her undergraduate studies, she enrolled in medical school on a military scholarship. While she thought she would focus on family medicine, after getting assigned to a ship during Operations Desert Shield and Desert Storm, she loved keeping her shipmates healthy for nine months while out at sea.

“That’s when I learned that there was an actual specialty called preventive medicine,” she recalled.

Fast forward to three years ago. Dr. Coyle was recruited to serve as the public health director of the Cabarrus Health Alliance in North Carolina. Thanks to a grant from the North Carolina Medical Society, she was one of six physician champions statewide for the National Diabetes Prevention Program (DPP).

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The main goal of the grant-funded project, which is part of the DiabetesFreeNC initiative, is to close the gap between public health efforts and clinical care because, as Dr. Coyle noted, “80% of what's killing Americans today we could prevent if we just got them to adopt four behaviors”—eat healthy, be more active, lose weight and not smoke.

“One of the things that throughout my career has been sadly and painfully obvious is that a lot of times the medical community is not working with the public health community,” said Dr. Coyle. “Because of that, the health care system often is not serving and best meeting the needs of the people it is trying to keep healthy.”

Early on, however, she discovered it wasn’t just patients who were unaware of the program. Physicians didn’t know it existed either.

Still, even if every physician was aware of the DPP, many would still face some stiff headwinds to referring patients into it.

"One of the biggest obstacles is the time factor,” Dr. Coyle said. “As more doctors become employed by health systems, they feel stressed about stopping and taking time to counsel and educate. Prevention education must compete with other priorities, and sometimes providers run out of time.”

Nevertheless, there are several easy steps physicians can take to overcome this lack of time and ensure vastly more patients get a referral to the DPP.

First “is that doctors quickly learn what the DPP is and where it is available in their communities,” Dr. Coyle said.

Another is to incorporate a referral into the EHR.

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“Doctors often can't stop and go find brochures, but if they incorporate it right into the medical record, they only have to click a button,” she said. 

“The third thing I strongly suggest is they put together a one- or two-sentence elevator speech for patients,” Dr. Coyle said. “For example, ‘I see that you have pre-diabetes. That means you don't have diabetes yet, but if you don't make lifestyle changes, you’re likely to develop diabetes. You have the power to prevent this, and I'm going to refer you to a program that's going to help.’”

After all, it’s not just that patients are known to take their physicians’ advice; it’s also that they likely will never hear about the DPP otherwise.

The AMA Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National DPP lifestyle-change program based on their individual needs.