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The vital role of metabolic health in whole-patient and patient-centered care

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Written by Molly McElwee Malloy, RN,CDCES

No matter your path we are all striving to live our best life, whether you have just been discharged from hospital recovery, you are undergoing remote patient monitoring or you use several e-health applications to document your health journey. Everyone wants to be well and feel well. Here’s where we start putting metabolic health front and center to allow you – no matter where you are starting – a path forward to wellness.  

 

Depending upon your source, Metabolic Health is the merging of several different clinical and physical indicators including blood glucose in a healthy range; waist circumference > 35” for women and < 40” for men; and blood pressure, cholesterol, and triglycerides all within a healthy range.  We’ve known that these metrics were important for a while, but we’ve never really called the cluster of metrics anything – likely for good reason. The health system in the United States is fractured. Here’s a great example, you may see an endocrinologist for your blood glucose, blood pressure by your primary care physician, cholesterol and triglycerides could be managed by either one or neither depending upon your care, and your waist circumference – well, you tell me when that was last measured in a medical visit? I know I’ve become accustomed to telemonitoring and telehealth visits – which are great time savers, but sometimes you need to be seen live and in person.  

 

Including all of these metrics together gives a better picture of how you may be doing from a metabolic standpoint. Why is this important? If things are off balance metabolically, you become off balanced in other ways. Maybe with blood glucose spikes you become tired after meals; you may experience a “background hunger” that feels like you always need a snack. You may feel extra tired upon exertion because of this, and your blood pressure elevation may be giving you headaches, blurry vision, and your anxiety can be elevated. Now your waist circumference – that is something you may not be aware of initially. “Central obesity” as it is termed can contribute to higher rates of depression, cardiovascular disease and cancer. All in all, when metabolically things are out balance you just don’t feel well. For the record, this is not a body shaming article, no matter where you are in your health journey getting better health can be attainable. Everyone walking around like Barbie and Ken is not a realistic goal (he’s just Ken), but healthier we can do.  

 

Taking into consideration WHOLE BODY health, feeling well needs to be right at the top of things. When generally you don’t feel well at baseline – and I don’t mean you have a cold- you just plain don’t feel your best, it is much harder to do all the things you need to do. This can be work, exercise, taking care of yourself or family and getting enough quality sleep.  

 

Meanwhile, there is a lot of talk about “patient-centered care” and what this looks like. The basics of patient-centered care address specific health needs and desired outcomes from the patients perspective. So when we combine the metrics in metabolic health, we get a pretty good idea of where you are and how far that is from where you want to be. Sometimes we might say, “I just wish I had more energy” and this can be related to things not going great metabolically. Further, there are five foundational elements around “whole health” including that it is people-centered, comprehensive, and holistic, upstream focused (outcomes), equitable and accountable and grounded in TEAM well-being.  

 

Let’s unpack the this a bit more. Patient centered care and person-centered care overlap, comprehensive and holistic care means we are not separating parts of health into different buckets, we look at not only the clinical values of the patient, but how they feel and where they want to be. It’s “upstream focused” which is a complicated way of saying, the goals need to be aligned with the outcomes desired. We can come back to this one – it’s important. The care needs to be equitable and accountable – you and everyone else deserve to feel well, have access to care and the service you receive and the effort you put in hold that accountable. Now what about team well-being? Team well-being can be interpreted many ways, but the simplest is that the team – your goals, your providers goals and the care prescribed are aligned.  

 

Now a quick note on outcomes and being “upstream focused.” Here’s where it’s really important to get on the same page – patient and clinician. If my goal as a patient is to be able to make and consume healthy dinners three times a week and your goal as my doctor is to have me log everything I put in my mouth for the next month – we are not aligned. So much so that I might become so inconvenienced by the ask of this task that I stop even caring if I try for three healthy dinners a week. Realistic and attainable goals allow for “upstream focused” outcomes to become true. So be honest – everyone – what is the goal and how do we get there. New habits don’t come easy, and these small gains in outcomes that can be made steadily over time have a good chance of sticking.   

 

How do we move to whole patient, patient-centered and metabolically health care together? We start looking at the clinical metrics as a whole – blood pressure, blood glucose, waist circumference, cholesterol and triglycerides – these become ONE part of how we are doing. Since these things can evolve slowly over time, I don’t recommend waiting until you don’t feel well – ask that these be looked at for you as a patient and clinicians start putting this puzzle piece together in a thorough approach.  

 

Changing the way we do things is hard for patients and clinicians alike. If you are reading this, let’s make a pact – as patients we will as for our metabolic health to be evaluated. As clinicians we will check and see if someone is metabolically healthy and if not, we will address this – however we can. Maybe you prescribe use of a professional CGM to use for 10 – 14 days and truly evaluate what and how we can improve. Maybe as clinicians we truly consider the value and, in my opinion, true magical powers of GLP/ GIP classes of drugs in the fight against obesity and metabolic syndrome. It’s time we all took a look at this together and consider the entire health for everyone by making metabolic health a priority. 

At Locus Health, Molly is working on integrating diabetes device data into the electronic medical record. If you’d like to learn more about this effort for your health system, or your device, please click here.  

 

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