Diabetes is the most expensive chronic disease our nation faces, costing the United States over $400 billion in combined medical costs and loss of productivity. Yet, with this knowledge, one must wonder if enough is being done to solve this epidemic and what we, as medical professionals, can do to improve outcomes.

As we prepare for National Diabetes Awareness Month in November, we may want to consider how we can ensure that every patient with diabetes receives optimal care for their lower extremities, which could improve productivity for patients and the organizations they work for, as well as decrease associated astronomical costs.

This is no easy task, as we have to look at this medical crisis from several angles:

• How can we collaborate with other medical providers to increase awareness of our valuable role and ensure that they include referrals to our offices as part of their treatment plans for their existing patient base?
• When we bring these patients into our offices, how can we improve their ability to be compliant, enabling us to provide effective treatments and support healthy lifestyles?
• Finally, how can we improve our "footprint" in the public's eye to increase awareness of the role we play as podiatrists and decrease the number of amputations that many of us must perform?
  

Here are six strategies the podiatric community should consider to address and improve the diabetes crisis that we are faced with:

1. Podiatrists should unite together as one voice and represent our local community in Pennsylvania, and participate in community outreach events that present a comprehensive message about managing diabetes, providing community-based education, raising awareness of diabetic foot care, the risk of diabetic foot complications, and the preventative podiatric treatments necessary. Our active presence and engagement will improve our position in public forums.

2. Strengthen the podiatric brand and its role in diabetes management on social media as an educational sounding board for followers to increase their awareness of the importance of podiatric care in diabetic patients. Social media is a resource that allows us to break boundaries and "speak" to our target demographic, share educational content, and highlight success stories, which may help increase awareness of podiatry.

With millions of people regularly accessing the internet to improve their medical knowledge, developing and sharing educational content on social media that resonates with individuals seeking or receiving treatment could be beneficial.

Furthermore, a series of social media posts developed throughout November for Diabetes Awareness Month, utilizing hashtags such as #NationalDiabetesMonth and #DiabetesSupport, may reach a wider audience.

3. Seek opportunities to reach other medical providers in a setting such as a clinical conference that may allow for time to devote to collaborating with different providers, such as vascular surgeons, endocrinologists, and dietitians. Increasing our presence in venues such as clinical conference settings will enhance our ability to develop relationships within the broader medical community and foster effective collaborations with key players in the diabetic medical community. This can lead to increased awareness of the importance of our role and direct referrals from these providers.

4. Share testimonials from patients to be impactful and relatable. As many of us work with diabetic patients and showcase their efforts to comply with treatment plans, we may want to consider asking for a release to be signed and for a patient to provide a testimonial that a diabetic patient may find relatable and learn from.

5. Creating and distributing marketing assets tailored to patients and the medical community would expand our reach and improve outcomes in both attracting and treating diabetic patients.

6. Implementing strategies to treat noncompliant patients to improve treatment outcomes can support both patients who want to do well and doctors who experience low job satisfaction and burnout when they are unable to engage patients in the manner in which they desire.

Noncompliance among patients with diabetes is associated with increased emergency room visits, frequent hospitalizations, and high treatment costs. The mortality rate among patients who do not adhere to their treatments is significantly higher than that of other patients. Reducing noncompliance can have a significant impact on the overall medical costs our country is experiencing.

Noncompliance is a complex issue and is usually not a deliberate refusal. Patients may have low health literacy, and they may not understand their diagnosis or the importance of follow-up care. Assessing patients' goals, capabilities, and barriers puts them at the center of the interaction about diabetes management.

Noncompliant patients may not fully understand their condition or the potential consequences of noncompliance. While the patient is responsible for the majority of diabetes care, doctors must recognize that they have little control over how patients manage their condition between office visits. It would benefit the doctor-patient relationship if time were taken to investigate the reasons for noncompliance.

Some of these common reasons include:

• Lack of understanding - Providing resources to enhance patient education through written materials (and making these materials available in Spanish and other languages) and using plain, concise language instead of medical jargon have been known to improve compliance.
• Unaffordability of medical treatment - The high cost of medication and medical supplies can prevent a patient from adhering to their treatment. Practices that offer a wide variety of medical supplies at lower costs compared to pharmacies and retail stores can be appreciated by patients who need to reduce their medical expenses, thereby decreasing noncompliance by providing solutions to financial barriers.
• Overall forgetfulness - Providing patients with weekly pill organizers can help simplify their complex medication regimens, improving their ability to stay organized and complete self-care tasks.
• Transportation concerns - Providing patients with information about local transportation services may help ensure they receive follow-up treatment.
  

Involving a patient in planning their treatment makes it more effective, as they are more likely to adhere to a plan they helped create. Collaborating with other podiatrists to learn what solutions have worked for them to improve noncompliance can also be helpful.

Podiatrists working collectively as one voice within our Pennsylvania Podiatry Medical Association position us as a powerful force. Leveraging our position in the medical community to be "present" is key. Together, we are a powerful collective force that can support one another, other medical professionals, and the patients we treat. Operating as one unit to fight the diabetes crisis is the only way we can reverse our current medical emergency.

Matthew Sowa, DPM, is a podiatrist practicing in Fleetwood, Pennsylvania. He serves on the PPMA Board of Directors.