Deterring a Deadly Disease
Diabetes is near epidemic, but we’re getting smarter about it. Here’s how.
by Jennifer Marie Zeberkiewicz Published September 18, 2008 at 05:48 AM
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Beebe Medical Center in Lewes offers general diabetic education classes, as well as specialty classes on nutrition, carbohydrate counting, use of insulin pumps and diabetes in pregnancy. Beebe also offers individual counseling for persons with diabetes, as well as high-risk family members, and constantly educates health and medical professionals.
The Diabetes Care Center at Bayhealth Medical Center offers group education classes, as well as one-on-one counseling, at both Bayhealth’s Milford and Kent General campuses. Bayhealth also offers free diabetes screening at both campuses on Wednesdays. “We get about 5 to 10 people each week, and they wait to get results,” says Nina Pletcher, a certified diabetes educator. “If anything comes back abnormal, we recommend referrals and offer information. It’s not a black hole. We can provide follow-up options.”
All of the diabetes education centers around the state accept referrals from any physician. “Diabetes educators in these centers are prepared to delve deeper into reasons why patients may not be controlling their diabetes well and help motivate them to do better,” Pletcher says. “Then we can report our findings to the referring doctor.”
Christiana Care offers a comprehensive full-team approach to diabetes prevention and control. Nurse practitioners, dieticians, health psychologists, exercise physiologists, scientists and endocrinologists work together to care for patients.
“Christiana Care just started an exciting project funded by a large grant from the Ammon Foundation that has two focuses,” says Dr. M. James Lenhard, medical director of Christiana Care’s Diabetes & Metabolic Diseases Center. “We started a diabetes disease management program—managing people by group rather than just individual, which will examine trends and patterns. Right now, we’re studying Christiana Care employees to see what the best course of action is to help manage a person’s condition. Most diabetics aren’t managed by an endocrinologist. It’s generally their primary care physician, so we want to make it easier for the physician to get information and help the patient.”
Lenhard would like the program to be used as research so it can expand. He’d like to offer telemedicine via the Internet so patients and caregivers can consult instantly about changes in medication and other issues.
The second part of the program is an adolescent obesity prevention program. “Type 2 is becoming a huge epidemic for children,” Lenhard says. “We did a study of 14-year-old high schoolers, and we discovered 28 percent were pre-diabetic. Almost all of those with pre-diabetes were a result of obesity and a sedentary lifestyle. We’re moving forward by partnering with a number of institutions such as Alfred I. duPont Hospital for Children to help with adolescent diabetes prevention.”
So what does it all mean? Outcomes won’t be available until after 2010, but on The Commonwealth Fund State Scorecard on Health System Performance report of June 2007, Delaware ranked high for the percentage of adult diabetics who received recommended preventive care. If the upward trend continues, outcomes will mean reductions in future healthcare costs.
Pletcher says that since the state began implementing standards and overall community outreach has improved, people with diabetes are being diagnosed sooner.
“There are tighter guidelines, and with the new criteria for diagnosing pre-diabetes, patients get more serious sooner,” she says. “People are becoming more proactive, and they seem to be less fearful to ask questions. This opens the door for educators to get the patient on board.”
Pletcher receives two to five calls a day from people newly diagnosed with pre-diabetes or diabetes who want to get more information or take classes or counseling.
“I’ve been tracking the knowledge level of people, and I don’t see people coming back as often,” says Tina Trout, a certified diabetes educator at Christiana Care. “They are showing a lot of initiative on their own to learn.” That’s real progress.