Diabetes services for adults provided at University of Iowa Hospitals and Clinics include individual and group diabetes education for inpatients and outpatients, insulin pump initiation and training, continuous glucose monitoring, and diabetes follow-up services in clinics and by telephone. A multidisciplinary team consisting of physicians, nurses, and a dietitian provide these services. Other disciplines are available as needed to provide consultative services including social services, psychiatric and mental health specialists, pharmacists, physical therapists, and prosthetists.

Group Diabetes Self-Management Education

The Group Diabetes Self-Management Education Program (Program) is Recognized by the American Diabetes Association and certified by the State of Iowa Department of Public Health. The Program provides approximately 200 adults with Type 1, Type 2, or gestational diabetes and their families with diabetes education each year. This education is directed at developing diabetes self-care knowledge and skills as well as helping with behavior change. The Program is available to both inpatients and outpatients and consists of formal group classes that are offered weekly over three days and are supplemented as necessary by individual instruction. The number of participants in each session is kept small to allow for group interaction and peer support.

The instructional staff for the Program includes the staff physicians and fellows in the Division of Endocrinology and Metabolism, nurse certified diabetes educators, and a dietitian certified diabetes educator. An advisory committee consisting of health professional, consumer and community members participates in planning the Program and evaluating its outcomes.

The content areas included in the Program are those specified in the National Standards for Diabetes Self-Management Education. These content areas are as follows:

• Diabetes disease process and treatment options
• Nutritional management
• Exercise
• Medications
• Monitoring and using results to improve blood glucose control
• Preventing, detecting and treating acute complications
• Preventing (through risk reduction), detecting and treating chronic complications
• Goal setting and problem-solving
• Psychosocial adjustment
• Pregnancy and diabetes (if applicable)

The Program has several unique features. Program participants eat their lunches each class day in the dining room of the Diabetes Education Center. This provides each participant with an opportunity to practice food selection with dietitian guidance and support. Staff physicians from the Division of Endocrinology and Metabolism teach the opening class which includes an overview of diabetes and long-term complications, a discussion of the benefits and risks of blood glucose control, and information about current diabetes research. This class reinforces to participants the importance of education and the role self-care plays in achieving blood glucose control goals. The diabetes education nursing staff also provides diabetes management services in diabetes clinics and by telephone. This provides Program participants with the opportunity to receive continued counseling and education as well as assistance with adjusting medications to achieve blood sugar control.

Continuous Glucose Monitoring

Continuous glucose monitoring has been available at UIHC since July, 2000. This monitoring is completed collaboratively by diabetes nursing staff and physicians from the Division of Endocrinology and Metabolism. Four Medtronic MiniMed Continuous Glucose Monitoring Systems are available as well as a dedicated computer for data download. This monitoring has been used for a variety of patients with blood glucose control problems including variable blood glucose levels, poor blood glucose control as evidenced by an elevated Hemoglobin A1c level, frequent episodes of mild to moderate hypoglycemia, episodes of severe hypoglycemia, and frequent episodes of hyperglycemia and diabetic ketoacidosis. Continuous glucose monitoring has also been useful in evaluating the effectiveness of a regimen as well as to demonstrate self-care skills. Use of continuous glucose monitoring data helps identify regimen changes that are needed to improve blood glucose control.

List of services