Diabetes affects nearly 25 million Americans, and that number is expected to grow substantially every year. It's the fifth leading cause of death in America, more than breast cancer and AIDs combined. And according to a report released last week from the Agency for Healthcare Research and Quality (AHRQ), it's a disease that’s costing Americans $83 billion a year in hospital fees — 23 percent of total hospital spending.
New technology is popping up all over in the medical community, from new diagnostic machines, to new ways of administering drugs, to an almost endless supply of self-monitoring devices such as blood glucose meters. But a technology often overlooked is one that could have the most impact-electronic medical records.
Are adults with diabetes better able to manage their disease if they can schedule same- or next-day appointments to see their doctors rather than sticking to appointments made in advance? The conventional wisdom goes that if people with diabetes can more quickly get in to see their doctors whenever problems comes up, the sooner they can receive treatment for it. However, an Indiana University School of Medicine study of 4,060 adults with diabetes being treated at 12 clinics showed that open-ended scheduling produced no benefit and, when it came to blood pressure control, actually worsened patients' conditions.
All 15 experimental coordinated care programs launched by Medicare in 2002 failed to generate net savings, and only two of them reduced hospital admission rates among patients with chronic diseases, including diabetes.
Can you imagine a hospital where the floors are carpeted, so you feel soothed and protected? Where the doors open silently so as not to jar your nerves? Where vending machines are filled with fresh fruits, and the healthier the meal in the cafeteria, the less it costs? How about elevator doors covered in exotic floral motifs, or a diabetes center where you never wait more than ten minutes to be seen?
Last March, an 11-year-old Wisconsin girl, Kara Neumann, died from diabetic ketoacidosis (a serious complication of diabetes that results when glucose is unavailable to the body as a fuel source, fat is used instead, and toxic byproducts of fat breakdown, called ketones, build up). Kara had undiagnosed type 1 diabetes. She was never treated by medical professionals because her parents believe that only God can heal the sick. They prayed for their daughter's health, but they did not seek medical attention.
Concerned about the growing number of Americans who are developing diabetes, Sanofi-aventis U.S. has launched the "Diabetes National Alliance" to provide healthcare professionals with information on the standard of care for people living with the disease.
Back in 1993, I published an article titled "Is Noncompliance a Dirty Word?" in which I expressed sadness that people with diabetes were being blamed by their healthcare providers for not following treatment advice (1). I suggested that the patient's "failure" might really be a failure of the partnership(or lack thereof)between patient and provider. Fifteen long years ago, I challenged diabetes educators to work with medical practitioners to change noncompliance from a dirty word to a rare occurrence. So, how are we doing today?
A study published in the Journal of Hospital Medicine has found that the glucose control practices at academic medical centers are below par and fail to meet the current standards set by the American Diabetes Association (ADA).
The treatment of diabetes has come a long way since Dr. Elliot Joslin wrote The Treatment of Diabetes Mellitus in 1916. But Dr. Joslin's idea that diet, exercise, and insulin (when it became available as therapy in 1922) are the keys to managing diabetes remains true today. This doesn't mean that diabetes is not a complex illness requiring ongoing education and individualized care. People with diabetes benefit greatly from the services of a team of health care professionals including a certified diabetes educator and an endocrinologist--a doctor who specializes in treating disorders of the endocrine system.
As the 76-million-member Baby Boomer generation ages-its oldest members are now 63-nursing homes are bracing for an unprecedented demand for their services. Along with increased pressure from the sheer number of patients, nursing homes will also have to deal with the skyrocketing number of seniors with type 2 diabetes.
A study published in the September American Journal of Nursing(AJN) indicates thatgraduated compression stockings were used incorrectly in 29 percent of the patients and sized incorrectly in 26 percent of the patients. Compression stockings play an important role in preventing the formation of deep vein clots that can result in pulmonary complications and death
It should have been a slam-dunk. My wife underwent two back-to-back surgeries to treat an eye melanoma. Through the surgeon, she had obtained written permission from our health insurance company to use his services and those of the hospital where he operated. Neither was in our specific insurance plan--in health insurance vernacular, they were out-of-network--which explains why the pre-approval was mandated.
“Let’s take care of the patient.” That must be the credo of hospitals that make U.S. News & World Report's “Best Hospitals” rankings, in which hospitals are judged not in routine procedures but in difficult cases across an entire specialty. In the nineteenth year of this annual review, hospitals are ranked in 16 specialties, from cancer and heart disease to respiratory disorders and urology. Out of the 5,453 hospitals put through a rigorous statistical mill, only 170 scored high enough to appear in any of the specialty rankings.
Diabetes classes or visits to a nutritionist by patients with diabetes are associated with lower hospitalization rates and reductions in medical costs, according to findings published in Diabetes Care.
For people with diabetes, healthcare is just plain more involved. Hospitalizations require extra work because you must control your diabetes during your stay, and insurance can be problematic because insurers are often unwilling to pay for what you need.
According to a May 2007 CNN opinion poll, 64 percent of us think that our
government should provide a national health insurance program for all Americans,
even if it would require higher taxes. So what's in the works?
Studies have already shown that people with diabetes do worse than
non-diabetics after being hospitalized for stroke, heart attack, and
heart surgery. Now researchers have found that they do worse after
being hospitalized for trauma (a physical injury) as well.
You have made a point of checking your blood glucose and getting your annual eye and foot checkups. You track your blood cholesterol and blood pressure. But now the pain in your hip is unbearable and interfering with your walking program, so your doctor suggests hip surgery. You will be admitted to the hospital for hip surgery, not diabetes.
Q: My mother, who is a "brittle diabetic," has been sent to a
skilled nursing facility for two weeks of rehabilitation following a
seven-week hospital stay. I am amazed and frightened at the lack of
concern for and attention to her diabetes care at the nursing home.
Analysis of several recent studies indicates that Avandia (rosiglitazone), a type 2 diabetes medication that's been taken by more than six million people worldwide, is associated with a 43 percent increased risk of heart attack and with a borderline-significant increased risk of heart attack-related death.
When it comes to your feet, it’s important to know where you stand. Foot problems are the most common reason for diabetes-related hospitalizations, and people with diabetes are up to fifteen times more likely to have a lower limb amputation than those without diabetes.
GlucoLight's continuous, non-invasive device is a novel approach to glucose monitoring in the acute care environment. Using optical coherence tomography (OCT), the device is able to measure blood glucose levels through a unique anatomical area in the skin that shows physiological changes that directly correlate to changes in blood glucose. The GlucoLight monitor displays real time glucose measurements with an initial single point calibration.
There are only about 5,000 practicing endocrinologists in the United States in this time of rampant type 2 diabetes, and most of those are on the coasts. According to Dr. Hossein Gharib, past president of the American Association of Clinical Endocrinologists, the Midwest could use at least 5,000 more endos, but the specialty just isn’t attracting enough new physicians.
While people with diabetes know that they face a long list of possible complications, it looks as if there’s one more to worry about: We now know
that diabetics also face a higher risk of colon cancer. However, there is some consolation in knowing that colon cancer can often be prevented with proper testing.
In hospitalized people with type 2 diabetes, Glucerna was found to have a “neutral effect on [blood glucose] control and lipid metabolism . . . compared with a high-carbohydrate and a lower-fat formula.”
Many patients who are treated with metformin (Glucophage) during hospital stays have medical conditions or undergo procedures that, when combined with metformin, put them at risk for developing lactic acidosis, a potentially life-threatening condition caused by a build-up of lactic acid that can lead to organ damage.
Giving intensive insulin therapy to patients with elevated blood-glucose levels in the surgical intensive care unit (ICU) of a hospital significantly reduces their chance of death, even if the patients did not previously have diabetes, say researchers in Belgium. Greet Van den Berghe, MD, PhD, and colleagues reported their results in the November 8, 2001, issue of The New England Journal of Medicine.
After four years on dialysis, with no sign that he was nearing the top of the transplant waiting list, Moshe Tati decided to buy a kidney. This was easier than he had imagined. Several months previous, the name and telephone number of an organ broker had been passed, furtively, around his dialysis group. At the time, Moshe did not think he would use the telephone number. He thought he would wait.
Want to get out of the hospital sooner? Your best bet is to find a team consisting of a doctor, nurse educator and a dietitian, all of whom specialize in diabetes. At the very latest, do it as soon as you enter the hospital. Make sure the people who will be caring for you in the hospital work with your diabetes team.
Dinner is at 5, but you usually eat at 7. Your attending doctor does not do the same things as you and your diabetes team. Your attending doctor knows you have a diabetes specialist but does not call the specialist. You routinely eat a bedtime snack, but nobody in the hospital brings you one. The insulin you use is Humalog, but it is not on the formulary. Neither is your ACE inhibitor.
Kaiser Permanente, a health maintenance organization, is offering an approach to care known as Diabetes Population Care Management. This system gathers comprehensive information about all aspects of a patient's medical treatments.
The Institute for Safe Medication Practices (ISMP) reports that 11 percent of serious medication errors involve insulin misadministration. The errors most commonly occur when an overdose is given, or when insulin is mistakenly administered in place of other medications. The direct cost of an inpatient adverse drug reaction can range from $1,900 to $5,900.
Adjusting to diabetes can be tough. But for teenage girls with diabetes it can be potentially fatal. Researchers have found that societal influences on teen boys and girls can affect their diabetes, and that in most cases girls suffer the most from these influences.
In addition to their many lifesaving skills, paramedics must also have expertise in treating people with diabetes in emergency situations. For instance, about once a year 36-year-old Craig Lloyd's sugars plunge unexpectedly into the 30s and he loses consciousness.
During a recent trip to visit my sister and brother-in-law I hit a piece of metal on the interstate and my front left tire was ruined. Changing the tire wasn't a difficult process, but it used energy that was not accounted for in my calculations of exercise, insulin and food intake.
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