by Michael O’Leary

 In a variation on an old joke, family medicine experts at Tufts University are urging doctors to “talk with the hand,” as an easy-to-remember approach to illustrating treatment goals for patients with type 2 diabetes.

 In an editorial in the February issue of American Family Physician, Allen Shaughnessy, PharmD and professor of family medicine, says that a simple use of one’s hand is an effective way to communicate with patients about the treatment priorities for type 2 diabetes.
(published site)
“Glycemic control is stuck in people’s minds as the primary goal of treatment, but evidence has existed since the 1970s that other interventions are of greater benefit,” Shaughnessy said in a press release. “Some degree of glycemic control is necessary to prevent symptoms. It’s just that the return on investment is low when we try to push patients with diabetes to get their blood glucose as close as possible to normal.”

 Using his hand, he demonstrates the descending order of priorities for intervention starting with the thumb as the highest priority and ending with the pinky relative to improving length and quality of life for those living with type 2 diabetes. The list includes:
  1. Stop smoking
  2. Control blood pressure
  3. Metformin therapy
  4. Lowering cholesterol
  5. Controlling blood sugar
“Our aim in proposing the ‘lending a hand’ is to communicate the most beneficial interventions patients can make to reduce their symptoms and risk of death from diabetes complications,” said co-author Deborah Erlich, M.D., M.Med.Ed., “But this model requires a shift in thinking away from the outdated idea that glucose reduction is most important, which may be a challenge.”

 According to the National Diabetes Information Clearinghouse, diabetes is a major cause of heart disease and stroke and the leading cause of new cases of blindness among adults.