Aggressive Care Boosts Diabetics' Overall Health

Doctor's watchful eye keeps risk factors under control

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HealthDay Reporter

THURSDAY, April 8, 2004 (HealthDayNews) -- When it comes to managing diabetes, more care results in better overall health.

That's the conclusion of a new study appearing in the April issue of Clinical Diabetes, which found that when diabetics were more intensively supervised by their physicians, their blood sugar, blood pressure and cholesterol levels were lower.

"This was a concerted effort to get physicians to follow the American Diabetes Association [ADA] guidelines for diabetes care," said the lead author of the study, Dr. Francis Solano, Jr., the chief medical officer of the University of Pittsburgh Medical Center's Community Medicine, Inc.

More than 18 million Americans have diabetes, according to the ADA. If the disease isn't properly treated, diabetes can have serious complications, such as heart disease, kidney failure and blindness.

In 2000, the University of Pittsburgh Medical System, which includes the practices of 220 primary care physicians, began implementing the ADA Standards of Care. Initially, approximately 125 physicians voluntarily began the project; eventually, participation was mandatory. At the end of the two-year study period, 95 percent of the physicians' offices were participating.

Physicians were educated on the ADA guidelines, given supporting literature, and taught strategies for teaching self-management to people with diabetes. Education was done during meetings or lectures, or through telecommuting for doctors in outlying, rural areas. All of the physicians were asked to keep track of any interventions, such as prescribing medication, and were given quarterly lab reports detailed their patients blood tests.

At the end of two years, blood tests on almost 16,000 people with diabetes showed an average HBA1C of 6.97 percent. HBA1C is a test that measures how well blood sugar has been controlled during the previous two to three months; according to Solano, the national average is nearly 8 percent. He said a 1 percent drop results in a 35 percent decreased risk of complications, such as eye, kidney or nerve problems.

For the study, the researchers tracked blood pressure and cholesterol management in 4,598 people. Almost 80 percent had lowered their blood pressure below 140/90 -- the figure deemed to be hypertension -- and 51 percent managed to get below 130/80. Just over three-quarters were able to get their LDL (the "bad") cholesterol levels under 130 milligrams per deciliter of blood -- a figure of under 130 is considered desirable -- and almost 43 percent managed to get this level under 100 mg, according to the study.

"They really hit the nail right on the head with their model," said Dr. Michael Fleming, president of the American Academy of Family Physicians. "Their data backs up what we all probably intuitively knew. You need to have a medical home, a physician that you see on a regular basis who knows you. But the big issue is time. Time is limited, and most physicians aren't in an integrated system [like the one in the study]."

Dr. Daniel Nadeau, medical director of HealthReach Diabetes of Exeter Hospital in Exeter, N.H., said the study's results were encouraging. "In a fairly short time, they were able to make a real difference in their patients' outcome," he noted.

In a perfect world, diabetics would have an endocrinologist help them manage their disease, but Nadeau said that there simply aren't enough of these specialists.

Another important issue in diabetes management is cost. Dr. Stuart Weiss, an endocrinologist at New York University Medical Center, said, "Diabetes is a time-consuming, poorly compensated disorder."

Weiss noted that in the study, the researchers were able to make a difference in blood sugar, blood pressure and cholesterol control without large additional expenditures.

Using nurse practitioners for education and monitoring can be a good way to keep costs down without sacrificing care,he added, noting also that newer glucose monitors store blood sugar readings and can be downloaded onto a doctor's computer before the patient's visit.

"This disease is treatable," said Weiss, and "with good monitoring and good control, some of the complications can be delayed or hopefully avoided."

Solano says the five most important factors in diabetes management are controlling blood sugar, cholesterol, and blood pressure, and getting your eyes and feet checked on a regular basis.

More information

To learn more about diabetes, go to the American Diabetes Association (ADA). The ADA also offers advice on who should be on your health care team.

SOURCES: Francis Solano, Jr., M.D., vice president, physician services division, and chief medical officer, University of Pittsburgh Medical Center's Community Medicine, Inc., Pittsburgh; Stuart Weiss, M.D., endocrinologist, New York University Medical Center, and clinical assistant professor of medicine, New York University School of Medicine, New York City; Daniel Nadeau, M.D., medical director, HealthReach Diabetes of Exeter Hospital, Exeter, N.H.; Michael Fleming, M.D., president, American Academy of Family Physicians, and private practice, Shreveport, La.; April 2004 Clinical Diabetes

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