Diabetes Awareness Month and Podiatry

This podcast was created in partnership with the American Podiatric Medical Association. 

Welcome, everyone, to Podiatry Today Podcasts where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr.

Jennifer Spector, the assistant editorial director of Podiatry Today. In this episode, we partner with the American Podiatric Medical Association to mark

Diabetes Awareness Month with our guest, Dr. Crystal Holmes. Dr. Holmes is currently a clinical professor with University of Michigan Health System. She

founded the Michigan Medicine Podiatry Program in 2006, and still serves as the program director. She also has an active role in the training program for the

University of Michigan Podiatry Research Fellowship in limb preservation wound care and diabetes related lower extremity complications. She's had

numerous national and international leadership roles, and is a past president of the Michigan Podiatric Medical Association. She has research interest in

diabetes limb preservation, and serves as a principal investigator in the Diabetic Foot Consortium. We are thrilled to welcome Dr. Holmes today to speak more

about the importance of Diabetes Awareness Month in podiatry, both for patients and clinicians. Thank you so much for being with us today.

Why do you think having a month such as Diabetes Awareness Month is so important?

So it's really very simple. Knowledge is power, and the more we learn as clinicians and researchers, and the more we share with our patients, their families,

communities, and other health specialties, the better care we're going to give and the better outcomes for our patients with diabetes, and that's what it's all

about. We want them to make the best choices possible and receive the best care.

So that being said, what do you feel is one of the biggest challenges that DPMs might face when it comes to diabetes?

So this is a really great question, and I think that the answer to this question, is not really one, it's two. And the first is messaging, and the second is lifestyle.

And so what I mean by messaging is that I'm very fortunate to be in an environment where I'm training brilliant minds of tomorrow and wonderful clinicians

that are making changes. And so one of our fellows, Dr. Burmeister, she was a fellow at the time, she's now an attending with us. She stayed on with us at the

University of Michigan.

But, we had a conversation with a patient about staying off of their foot a hundred percent of the time, and the patient said, "Absolutely. I'm staying off of my

foot a hundred percent of the time." And the patient came back, their wound was really not worse, but certainly not better, and I asked again, "Are you

staying off your foot a hundred percent of the time?" And they said, "Yes, a hundred percent of the time." I said, "So tell me when you wear your offloading

shoe." And they said, and this is an important note too, I'm going to come back to that later, "I wear my offloading shoe every time I leave the house," and my

head just dropped into my hands because that's not a hundred percent of the time, right?

And so what Dr. Burmeister did in a study as a fellow is she looked at that messaging, and she actually surveyed patients and found out that the messages that

we send aren't always received, and one of the biggest examples was that patients don't understand what offloading means. They understand pressure relief,

and they understand if you tell them you have to wear it inside your house, outside of your house, when you come to the doctor, when you're going to the

grocery store. And so we have to be very specific and very detailed in our messaging, and sometimes that can be difficult when we're limited in time and

things are complicated, but messaging is really, really important.

The second part of that is lifestyle. I think that's really difficult for all providers, everyone, everywhere. We're less active. We're having more processed foods

in our diet, there are resource and access issues to healthcare, and that's increasing our rates of obesity. It's increasing our rates of diabetes. And so just the

lifestyle that patients live really makes it a challenge, and so we can't necessarily fix the lifestyle part, but I do think that we have an obligation to work on our

messaging and connecting the dots for our patients.

And speaking of connecting those dots and controlling the messaging, in your practice and in your colleagues' practices, what types of patient education

or outreach have you found to be most impactful or most effective for your patients with diabetes?

The number one thing is personal connection. So when patients connect with me and they have their diabetic foot exam or an ulceration that I'm managing,

I'm telling them their specific risk. So not the overall risk that they're reading about, but specifically, "You have neuropathy. Your neuropathy is mild,

moderate, or severe. Your ulceration is in a state where we're worried about infection, amputation, or it's stable," et cetera. Wherever they live is where you

have to teach them, and you have to teach them at their level. So that one-on-one messaging and that one-on-one connection I think is really important. But

I'm also someone who I'll use whatever I can. So I'll reinforce that with reading materials that we'll send electronically. We have a patient portal, which is our

EMR system, way to connect. I'll send it via the patient portal. We have pamphlets, we do videos, we do webinars, we do everything that we can. We go out

to the community and do community outreach. So I don't think there's one way, but the most important way is to have that connection with your patients

and be able to give them their specific risks.

So, are there any innovations or emerging thinking that you're excited about when it comes to the future of diabetes treatment, including that for diabetic

foot disease?

 I happen to be extremely fortunate to be a part of the NIDDK's Diabetic Foot Consortium. And so the Diabetic Foot Consortium is the first consortium to ever

be designated for the diabetic foot, and what we were charged with was coming up with biomarkers for predicting diabetic wound healing. And if you think

about a biomarker that we use frequently, and I'm just going to give an example, when a patient has an infection, we do infection and inflammatory labs,

right? And although they're not 100%, they give us a gauge. Is the patient infected? Do I need to put them on antibiotics? Do they need to be admitted? Do

they have osteomyelitis? But we don't have anything that tells us when we have a wound. Will this wound heal? Will it heal? Will it be a wound that'll heal in

the specified amount of time? Will we need to use adjunctive therapies? Will it respond to our treatment modalities? And so the consortium has really been

charged with trying to find a biomarker. And so I am delighted and excited. We've got several things that we're working on.

The other part of being a part of the consortium is that it has really spawned off a lot of wonderful research ideas for young clinicians. And so we actually

have a podiatrist, Dr. Schmidt, who's on faculty with us. He's actually the first podiatrist to ever receive a K award. And so that is really a phenomenal thing for

our specialty. It really shows that the research that we're doing is on par with all of the great minds in our country, and so I'm really excited about the

possibility for us actually coming to the point where maybe we have some good diagnostic and predictive tools. So it takes us back again to the importance of

this month, Diabetes Awareness Month, because we want to improve outcomes. That's what all of this is about. Knowledge is power.

Is there anything else that you would like to add?

I think the biggest thing is for us to stay connected and engaged. So don't give up. It is a whirlwind of managing patients with diabetes. There's highs and lows.

We do have some losses, unfortunately, but we do have to focus on the goal, which is making patients and our community better.

Since it is so much about knowledge being power and because this is about awareness for diabetes, if there are any patients that might be listening to this

podcast, what would you like them to know about podiatry's role in the treatment of diabetes?

So, what I'd say to them is, number one, your podiatrist, your foot care specialist, your front line, so to speak, into maintaining your foot health. So when you

have diabetes, it is recommended that you have a foot exam at least every year. So it goes back to the question that you asked, right? You should be risk

stratified and find out should you just go annually or should you go several times a year based on your particular risk, and developing that relationship so that

you have someone to call immediately, if ever you have a problem or if there's a fire. It's not impossible, so don't feel like it's impossible, but sometimes it can

be a challenge to get in to see someone if you have an emergency, right? Then you're stuck going to the emergency room. But if you have someone that you

can connect with. And podiatrists really are the specialists that are on the front lines managing diabetic foot disease. I just encourage them to come into our

offices and learn more.

Jennifer Specto...:         Thank you so much, Dr. Holmes, for sharing your insights. We really appreciate you joining us today, and can't wait to hear more about your research and that of your team. Thank you as well to the American Podiatric Medical Association for their partnership on this podcast. Be sure to tune in to future episodes on podiatrytoday.com and on your favorite podcast platforms.