Volume 7
December, 2006
Contents
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Diabetes: Excellent Care Pays
 Seven of every 100 Americans have diabetes: In Eastern Pierce County
alone, that amounts to over 15,000 people. Most diabetics have type 2
diabetes, or adult diabetes, and around 1/3 of them have not been
diagnosed, and aren’t being treated. More startling yet, another 19% of
Americans have pre-diabetes, meaning they have elevated blood sugars,
but do not –yet- meet diagnostic criteria for diabetes.
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Diabetes is one disease for which preventative care and good disease
management has conclusively been shown to result in fewer complications,
fewer hospitalizations, and reduced health care costs for diabetic
patients. If you have diabetes, you are saving not only the cost of
medical care, but the pain and anguish of medical procedures and
conditions that include serious vision problems, dialysis, heart
attacks, infections and even amputations.
In our society, people change jobs and employers change insurance plans
frequently, which discourages health insurers from paying for preventive
care. The motivation for insurance companies, the savings in what they
pay out, needs to be immediate and measurable. The cost savings in
diabetes management are so dramatic, and so immediate, that insurers are
anxious to get patients and their physicians to work to achieve
treatment goals. At Sound Family Medicine, we want you to get this care
because we want you to stay healthy, and avoid diabetic complications.
There are five major areas of diabetes care that lead to reduced
complication rates. Surprisingly, control of blood sugars may not be the
most important.
1.Blood pressure control. A person with diabetes needs to maintain lower
pressure than those without. What is considered upper normal blood
pressure for most of us can, for a diabetic, lead to complications,
including kidney failure and dialysis, heart attacks, and disease of the
arteries to the legs and feet. The official goal blood pressure for a
diabetic is less than 130/80.
2.Cholesterol control. For our patients with diabetes, we work
aggressively to lower the LDL (bad) cholesterol, which reduces the risks
of heart and artery disease. The LDL goal in diabetics is less than 70.
A statin type medication is very often needed to achieve this.
3.Blood sugar control. Blood sugar control in type 2 diabetes can be
very challenging. Weight loss, diet, and exercise are key. In addition,
oral medications and, at times, insulin are needed. Monitoring control
with office visits and measurement of Hemoglobin A1C every 3 months is
recommended. Normal Hemoglobin A1C levels are less than 6%. With
diabetes, less than 6.5% is excellent, and less than 7% good.
Complication rates increase dramatically as the level gets over 8%.
4.Tobacco use eliminated. If a diabetic smokes, the risk of heart
attack, peripheral artery disease leading to leg ulcers, infection, and
amputation are greatly increased. Quitting smoking is critical for
people with diabetes.
5.Monitoring for and management of complications. Getting annual
professional dilated eye exams to look for early diabetic eye disease at
a time when treatment can prevent progression to blindness is important.
Annual urine tests should be done to look for protein leakage, a sign of
early diabetic kidney injury. Medications can effectively delay or
prevent progression of kidney failure and dialysis. Checking for foot
sensation at office visits can detect early loss of nerve function and
sensation to the feet, and allow you to be more vigilant in foot care.
Yes, that’s a lot to remember, but relax. All of the family physicians
at Sound Family Medicine are very familiar with these guidelines, and we
are working hard to help as many of our patients with diabetes as
possible meet the guidelines above.
Your part is to schedule regular office visits. Every 3 months is the
standard of care set by most experts. You will need to work with your
doctor to personalize a treatment regimen best for you.
What is difficult for you may be easy for other patients, and vice
versa. We can work together to help you stay healthy.
More information is available at the following links:
http://www.diabetes.org/about-diabetes.jsp
http://www.diabetes.org/diabetes-statistics/cost-of-diabetes-in-us.jsp
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