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Deterring a Deadly Disease

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Dr. M. James Lenhard is director of the Diabetes and Metabolic Diseases Center at Christiana Care, which has started a program to manage care of diabetics by group, examine trends and patterns, then find ways to better treat individuals. “Most diabetics aren’t managed by an endocrinologist,” he says. “It’s generally their primary care physician, so we want to make it easier for the physician to get information and help the patient.”  Photograph by Christian KayeWhen it comes to diabetes, Delaware has declared war.

As the condition spreads, the state, local hospitals and other health organizations have launched many initiatives to combat its prevalence. And they’re starting to work.
“There have been great accomplishments over the past several years toward improving the quality of care for people living with diabetes in Delaware,” says Donald Post, director of the state’s Diabetes Prevention and Control Program. “However, there is much more work to be done, especially as we move in the area of primary prevention of type 2 diabetes. One must keep in mind that diabetes is a complex disease, a disease that requires daily monitoring and management.”
Diabetes is a disease in which the body does not produce or properly use insulin, a hormone needed to convert sugar, starches and other food into energy. The cause is not understood, though genetics and environmental factors such as obesity and lack of exercise seem to play major roles.
Diabetes can be deadly. Most diabetics have health problems such as high blood pressure and cholesterol, which increase the risk for heart disease and stroke. More than 65 percent of people with diabetes die from heart disease or stroke.
Delaware ranks 18th for prevalence of adult diabetes in the United States. According to the U.S. Centers for Disease Control, 56,600 Delawareans age 18 and older have diabetes. It has become the fourth leading cause of death for African-American women and sixth for African-American men. About 9.5 percent of Latino Americans aged 20 years or older have been diagnosed with the disease. About $490 million is spent each year in Delaware for diabetes and its complications.
As a result the Delaware Division of Public Health’s Diabetes Prevention and Control Program developed the statewide Plan to Prevent and Control Diabetes in Delaware in 2002. The plan outlined steps for improving the economic, physical and mental burden of the disease till 2010.
The program also teamed up with the Delaware Diabetes Coalition, which helps set standards of care for diabetics and helps develop public policies and plans for prevention and control.
According to Post, progress has been steady over the past five years.
“To provide consistency in the way Delaware provides patient care, our program, working with the Medical Society of Delaware, designed and distributed in-patient and out-patient diabetes guidelines and this year will be distributing pre-diabetes guidelines,” Post says. “Utilization of the guidelines and following the recommendations for exams and tests, greatly contributes toward good diabetes control.”
Since 2002, the Delaware Pharmacists Society has screened more than 10,000 people for the disease. The society doesn’t diagnose, but it does refer patients to physicians when necessary. And donors to the Blood Bank of Delmarva can be screened for free, if they so choose. Post estimates that 50,000 people will be screened in 2008.
By mid-summer, 400 people were identified as diabetic. “Hopefully this will be a trendsetter for other blood banks across the nation to execute mass screenings in their state,” Post says.
With the Delaware Department of Education, the Division of Public Health distributed more than 300 blood glucose monitors to all Delaware schools. “These meters will help keep the child healthy in the school setting,” Post says.
Hospitals are waging their own war against the disease.
 
Deterring a Deadly Disease continues on page 2
 
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.

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