Margaret Powers, PhD, RD, CDE, has long been fascinated by the power of food and specifically its effect on people’s emotional, nutritional and physical needs. It is what drove her to her career specializing in diabetes care and research. Serving as a clinician and research scientist at the International Diabetes Center at Park Nicollet Health Services in Minneapolis, Powers is president-elect for Health Care and Education at the American Diabetes Association.
Q: How has the growth of diabetes as a societal health problem complicated patient care?
A: At Park Nicollet Health Services we have a saying: ‘Diabetes every visit.’ Caring for diabetes cannot just be relegated to a diabetes-only visit. Its care and management influences other health conditions and vice versa. As a society health problem I sometimes wonder if we are taking diabetes seriously enough. Its costs are tremendous — quality of life as well as financial.
Q: What challenges do you believe nurses in particular might face with diabetes care in coming years?
A: Nurses are at the front line, interacting with people facing the everyday decisions about diabetes self-management. Nurses need to be aware of more than the food and medication aspects of diabetes. It is key to understand the clinical, psychosocial and behavioral aspects of diabetes. Many people with diabetes have diabetes-distress, the negative emotional responses — overwhelmed, hopeless and helpless — and perceived burden related to diabetes. It is important that nurses have resources to refer patients for needed support and to work as a team with these other supports.
Q: Please share about your research on performance improvement and continuous glucose monitoring.
A: My PhD is in education with a focus on performance improvement. Performance improvement looks at a situation and works to figure out the best solution for improvement. Although performance improvement is often used in businesses, I readily see its application in healthcare. It is similar to quality improvement that many healthcare systems use.
Several guiding principles in performance improvement are ‘begin with the end in mind’ and ‘be solution neutral,’ among others. These are key principles that guide clinicians in working with patients. In my work it is important to understand what the patient’s goals are — the end in mind — and to be open to a wide range of possible solutions. Continuous glucose monitoring is very fascinating and opening up a better understanding of food.
My initial research tested a methodology for using fixed meals in a small pilot study. The fixed meals varied in carbohydrate content and CGM was used to show the glycemic response. This methodology has now been used in several drug studies. The goal is to determine if there is a change in glycemic response to the food changes as other measures change as a result of a medication. And, can an initial response to the fixed meal predict a response to the drug and provide guidance on possible titration? Many drug studies focus on just the drug and do not look at what a person is eating. My research is adding that missing piece.