Hackensack Meridian JFK Johnson Rehabilitation Institute Physician Helps Craft New Guidelines for Diabetes Care

A Hackensack Meridian JFK Johnson Rehabilitation Institute physician has helped create new guidelines that, for the first time, recommend that people living with diabetes be regularly screened for disabilities and, if necessary, referred to rehabilitation specialists.

Talya K. Fleming, MD, FAAPMR, Medical Director of the JFK Johnson Stroke Recovery Program, was one of two physiatrists, or rehabilitation medicine physicians, involved in creating the latest American Diabetes Association (ADA) guidelines. The new guidelines are the first to include a section on disability management authored by two physiatrists. The guidelines set the standards of care in diabetes and serve as an essential guiding document and reference for clinicians, policymakers, and others across the globe.

“The goals of diabetes treatment are to prevent or delay complications of the disease and to optimize each patient’s quality of life. For many patients with diabetes, rehabilitation medicine can be extremely valuable to their overall health,” Dr. Fleming said. “I was honored to be involved in crafting these new guidelines.”

Diabetes is linked to health problems that cause disabilities, such as damage to blood vessels, nerves, eyes, kidneys, and extremities, such as the feet. Other complications include cardiovascular disease and stroke. The guidelines now recommend that an assessment of disability be performed at each visit. If a disability impacts a patient’s ability to function, a referral should be made to a health care professional specializing in disability. 

As a rehabilitation medicine physician, Dr. Fleming regularly treats patients with diabetes, including those with vascular disease and stroke. JFK Johnson Rehabilitation Institute also has a Prosthetic and Orthotic Team that provides comprehensive evaluations and lifetime management to patients with limb loss or neurologic dysfunction, which includes many patients with diabetes. Other disciplines such as physical therapists, occupational therapists, speech-language pathologists, and others at JFK Johnson Rehabilitation Institute frequently treat patients with disabilities related to diabetes.

To address and improve health equity, the guideline also highlights the importance of social determinants of health in caring for individuals with diabetes, as the rates of diabetes-related complications are higher in individuals who are from racial and ethnic minority groups as well as underserved populations. 

“Rehabilitation medicine has always been there to support patients with diabetes who face disabilities,” Dr. Fleming said. “Now the role of rehabilitation medicine is highlighted in this global document to guide clinicians.”

Sara Cuccurullo, M.D., chair, vice president, medical director of JFK Johnson Rehabilitation Institute, said the new recommendations may result in people with diabetes getting into physical therapy and other interventions sooner, reducing or delaying complications.

“Rehabilitation medicine can help patients manage the complications of diabetes,” Dr. Cuccurullo said. “Our therapeutic interventions and multi-disciplinary approach can enable people with this chronic disease to function better in their lives and to feel better. That’s what we want for all our patients.”

 The 2024 ADA guide can be found in the January 2024 Diabetes Care Journal: https://diabetesjournals.org/care/article/47/Supplement_1/S52/153956/4-Comprehensive-Medical-Evaluation-and-Assessment