The earlier the better for fighting diabetes

Nearly one third of people with diabetes don’t even know they have it.
That’s a statistic that Madigan Army Medical Center’s Diabetes Care Center hopes to lower, according to Sean Smith, the center’s program coordinator. The program has been working with Madigan clinics, primarily Family Medicine and Internal Medicine, to put more emphasis on detection and prevention.
“We try to diagnose as early as possible,” said Smith.
Part of this emphasis is focusing on patients who are at risk for developing diabetes, screening for family history, weight, diet, activity levels, and age (risk increases after age 40). They’re placing particular emphasis on screening for patients with prediabetes (those with glucose levels between 100 and 126), sending them to dieticians, and prescribing oral medications to reduce their glucose levels.
Just as worrying for the Diabetes Care Center as undiagnosed diabetes patients are those patients already diagnosed with diabetes who aren’t being seen regularly to help manage it. In 2013, the center saw about 2,200 patients, although Madigan has more than 4,000 patients diagnosed with diabetes.
“One of the problems that we have is most people don’t feel sick with diabetes. It’s one of those hidden diseases,” said Smith. However, he said, diabetes has a very serious potential for negative outcomes, including increased risk for cardiovascular disease, stroke, infection and other complications like neuropathy, blindness, and kidney failure.
“The problem is until a lot of that damage happens, most people feel just fine,” said Smith.
He emphasized that the Diabetes Care Center puts an individualized focus on diabetes management, since outcomes can be completely different for each patient. Unlike many other diseases, patients with very similar circumstances can require very different forms of disease management, ranging from changes in diet and exercise alone to requiring oral medication or insulin.
Smith and his team know that being diagnosed with a chronic disease can be challenging, and they focus on what patients are doing well in managing their diabetes and what their goals are. They work closely with patients to seek out what motivates them to be healthy, to problem solve with them and identify coping skills, Smith noted.
“We are coming up with goals that are patient goals, not goals that we like to see the patient have,” Smith said, noting that they work to break down goals into small steps and celebrate when each one is accomplished.
The Diabetes Care Center also offers several group educational classes for diabetes patients, including an introduction to diabetes, nutrition, insulin tips, medication management, and learning to live with a chronic disease. Their bi-monthly Forum is patient-led, with discussion topics chosen by patients. Smith describes it as an opportunity for patients to learn from each other, to include what’s working and what’s not in managing their illnesses.
“They can talk openly about some of their struggles. It’s very non-threatening,” he said.
The center is helping bring diabetes education directly to Family Medicine patients by advising the department on the development of its Diabetes Birth Month Annual Review, a program which began last September. The program (Diabetes BMAR) invites diabetic patients to attend a two-hour interactive class during their birth months that allows patients to form action plans through discussions with pharmacists, diabetic educators, optometrists, nutritionists, behavioral health providers and nurse case managers, said Lesa Tweet, a Family Medicine nurse case manager. The class also focuses on hand and foot checks, blood pressure checks, reviewing and updating labs and medications, flu shots, and retina eye exams.
The Diabetes BMAR sessions have also resulted in identifying some patients who require followup appointments to evaluate their current therapy or for education in self-management of diabetes, said George Dydek, a clinical pharmacist with Family Medicine.
Smith said the class brought in some followup patients with diabetes who failed to complete follow-on care.
“Diabetes in the past has had a stigma attached to the word, and we are trying to take that stigma away. Early detection, early prevention will result in better outcomes overall for our patients,” said Smith.

Suzanne Ovel wrote this article originally

Pat Spaulding learns to test his blood sugar level at the Diabetes Care Center's Essentials Class on Jan. 5 at Madigan Army Medical Center. The class gives an overview of diabetes, treatment and how to test blood sugar levels. (Suzanne Ovel/Army Medicine)
Pat Spaulding learns to test his blood sugar level at the Diabetes Care Center’s Essentials Class on Jan. 5 at Madigan Army Medical Center. The class gives an overview of diabetes, treatment and how to test blood sugar levels. (Suzanne Ovel/Army Medicine)

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