“There’s an increased risk of fracture in individuals with type 1 and type 2 diabetes, even with normal or increased bone density,” Dr. Kemmis says. Remain vigilant about the patient’s evaluation, medication management, balance and fall prevention, and physical activity modifications to lower fall risk, she advises.
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Explore This IssueMay 2018
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Also, help these patients find the right physical activity. “Tai chi may be an excellent option to provide safe, weight-bearing exercise that can improve balance and decrease the risk of a fall and fracture,” Dr. Kemmis says.
5. Know when to refer to an endocrinologist or back to the PCP.
There’s a major push right now to screen for diabetes when appropriate because of the large number of people affected by the disease, Dr. Miller says. If you treat a patient who has one or more risk factors for diabetes, send them back to the PCP or to an endocrinologist for screening, he recommends. Beyond diabetes, don’t forget endocrinologists when you find signs of other endocrinological problems, including undiagnosed thyroid or adrenal disease, Dr. Miller adds.
“Many endocrine diseases may present as a definitive rheumatic disease, such as calcium pyrophosphate dihydrate disposition disease, or as a vague rheumatic symptom, such as diffuse arthralgia,” Dr. Efthimiou says. “This is why close collaboration between the two specialties is important.”
When Dr. Efthimiou sees a patient with musculoskeletal manifestations of diabetes, especially diabetic cheiropathy, he will consult with an endocrinologist who may help both with better glycemic control and the musculoskeletal presentation.
Also, if you have a patient with steroid-induced hyperglycemia, during which the blood sugar shoots up but returns to normal when treatment stops, it’s worth a referral to the PCP or endocrinologist. These patients are at a higher risk for developing type 2 diabetes, Dr. Miller says.
6. Consider how better care for one condition affects the other.
When a patient’s blood sugars improve, this often helps rheumatological outcomes improve as well, Dr. Miller says. “I’ve seen patients with joint and muscle pain that act up when their blood sugar is unstable,” Dr. Miller says. “You get that stable, and the pain improves.”
Conversely, if medication and lifestyle changes improve a patient’s rheumatological disease, it can help with diabetes outcomes. Work with patients on the end goal of overall better health.
Targeting Better Care
Helping patients with both diabetes and a rheumatological condition should improve their overall health. Ideally and importantly, it will also decrease their already elevated risk for cardiovascular disease. “Fortunately, there are a lot of emerging data showing that successful management of the inflammatory disease activity with traditional and biologic disease-modifying anti-rheumatic drugs can eliminate that additional risk factor,” Dr. Efthimiou says.