Arkansas has one of the highest diabetes rates in the nation and many of these cases could be prevented.
The number of Americans with type 2 diabetes has increased 217 percent in the past 10 years to about 30 million people. Diabetes causes 230,000 deaths every year and the death rate is increasing. Another 86 million Americans have prediabetes – an abnormal blood glucose level.
Diabetes is the most common cause of blindness, kidney failure and amputations in adults, as well as a leading cause of heart disease and stroke. Increasingly diagnosed in children and teenagers, diabetes is now the third most prevalent, severe, chronic childhood disease in the United States.
Health care professionals have a crucial role in preventing, controlling and managing diabetes and prediabetes by identifying, implementing and evaluating effective interventions.
Fully a third of patients with type 2 diabetes do not know they have it. A third of those who have type 2 diabetes diagnosis are not receiving treatment. About 90 percent of the 86 million people with prediabetes do not know it. Most (70%) people with prediabetes will eventually progress to type 2 diabetes; 30 percent will progress to type 2 diabetes within five years.
According to a 2014 study, two-thirds of those with undiagnosed diabetes had seen a health care provider two or more times in the past year. Tragically, this is a lost opportunity to both improve outcomes and save health care dollars.
Because 70 percent of patients with prediabetes progress to type 2 diabetes, it’s important to be able to identify prediabetes risk factors. Only 6 percent of primary care physicians (PCPs) surveyed at a medical conference could identify the 11 risk factors of prediabetes, according to a study published in the Society of General Internal Medicine’s The Bottom Line this summer.
The 11 risk factors for prediabetes that should prompt screening, according to the American Diabetes Association, are:
- Age, risk increases in the mid-40s
- Obesity or a body mass index greater than 25
- Heart disease
- Family history of diabetes
- History of gestational diabetes
- Sedentary lifestyle
- African-American race
- Asian-American race
- Hispanic ethnicity
Diabetes/prediabetes prevention requires a two-pronged strategy. It should include both patient assessment of risk and patient education to improve self-management. Even small steps in management and control can make a big difference in disease progression and the incidence of diabetes complications.
Lifestyle changes are effective
Several studies of people with diabetes/prediabetes who make intensive lifestyle interventions show a 58 to 86 percent reduction in the incidence of diabetes, according to a study published in The Bottom Line. The study looked at the risk of developing diabetes within three years. Eighty-six percent of the study subjects who exercised 150 min. per week, ate a healthy diet and lost 7 percent of their body weight avoided diabetes. Using metformin without lifestyle intervention only reduced the incidence of diabetes by 22 percent. Weight loss was the strongest preventive behavior change. The study authors said diabetes prevention efforts are durable and can last up to 15 years.
Be proactive with diabetes risk
Consider implementing these changes in your practice to help slow the diabetes epidemic, improve patient outcomes and help control health care spending.
- Screen for diabetes and prediabetes beginning at age 45. The U. S. Preventive Services Task Force (USPSTF), an independent panel of health experts, recommends screening, beginning at age 45, for both type 2 diabetes and prediabetes with a simple, low-cost, fasting blood sugar test. Additionally, USPSTF recommended screening adults over age 18 who have diabetes risk factors. While this advice seems obvious, it’s not happening. A 2014 study found that two-thirds of those with undiagnosed diabetes had seen a health care provider two or more times in the past year. Only about 25 percent of patients report receiving lifestyle recommendations from their PCP regarding their diabetes/prediabetes status.
- Place screening protocols in your practice. For example, have staff identify, using your electronic health records system, all patients needing regular screening for diabetes/prediabetes based on risk factors. Make sure patient knows to arrive fasting for lab work.
- Emphasize the importance of self-management. Effective self-management can prevent diabetes’ devastating complications, or slow their progression. Support patients with diabetes by providing them with a booklet to record office visits; blood pressure, A1C and cholesterol; foot, eye and dental exams; immunizations; meals; and daily physical activity. Ask patients to bring this booklet to each visit. Monitoring his or her progress will encourage patient engagement. There are several good downloadable examples of this booklet on internet websites.
- Use AFMC’s free, downloadable diabetes awareness and management tools (in English and Spanish) on its website: https://afmc.org/product-category/practices/diabetes/ AFMC also provides patient self-management tools to clinics in the form of handouts, posters and downloadable files. These materials can be made available to patients through a patient portal or practice website. A patient portal is an excellent way to engage diabetes patients. For example, patients can test and monitor their glucose levels and enter this information on the portal to provide you with timely updates.
- Counsel patients with diabetes or prediabetes to eat healthy and get regular exercise. Encourage diabetes patients to regularly self-test blood glucose. Contact patients who are at high-risk for diabetes/prediabetes before they become overdue for follow-up care.
- Emphasize the importance of medication adherence. A 2009 study by the New England Healthcare Institute found that 33 to 50 percent of all patients in the United States do not take their meds as prescribed. Improving medication adherence means fewer hospitalizations and emergency department visits, fewer deaths, illness and lower health care costs. Spending $1 on diabetes medications saves $7.10 on health care costs.
- Contact AFMC’s Quality Outreach Services at 501-212-8631 for direct assistance with implementing best practices for your patients with diabetes. AFMC works directly with physician offices and providers to make diabetes screening a routine process. Patient education and routine screening by physicians reduces diabetes complications and associated costs.
- Consider writing a prescription to attend a diabetes self-management education program. Self management is an important intervention to encourage in your patients. Patients with good self-management knowledge and skills can significantly reduce the risk of (or reduce the progression of) serious complications such as heart disease, lower limb amputations, kidney failure and blindness. AFMC’s self-management efforts utilize the Gateway DSM and the Diabetes Education and Empowerment Program’s (DEEP) evidence-based curricula. Both curricula were developed for adult learners who are low-income, and members of racial or ethnic minorities. They can be successfully taught to people with low-literacy skills. Anyone with diabetes, prediabetes, and their relatives and caregivers are welcome to attend.
Your patients can call toll free 1-877-375-5700, option 2, to find a free diabetes class near their home.
These classes are making a difference. High-risk people with prediabetes, who completed the classes, reduced their chance of a diabetes diagnosis by 11 percent; reduced body weight by an average of 7 percent; attendees had an 8 percent lower chance of developing diabetes complications; and the chance of dying from diabetes was reduced by 2.3 percent, saving almost 5,400 lives a year. Another large study of people at high risk for diabetes showed that learning about diabetes management, lifestyle interventions to lose weight and regular physical activity, reduced type 2 diabetes development by 58 percent; 71 percent among people over age 60.
The classes are not lectures but hands-on learning with lots of visual, real-world examples. The free, six-week course (a total of 12 hours of instruction) and attendees will learn:
- how diabetes affects the body
- diabetes/prediabetes risk factors
- effective communication techniques to use with health care providers
- why it’s important to make lifestyle changes
- how to avoid complications
- effective use of medications
- ways to reduce stress
- how to identify symptoms of hypo- and hyperglycemia
- nutrition and practical ways to control food intake
- exercises to help control blood glucose levels
- the importance of their HBA1c, cholesterol and blood pressure numbers
Benefits to participating providers
Participation in the diabetes-prevention initiative offers your practice additional benefits and opportunities at no cost, including:
- Training on evidence-based diabetes curricula
- Education materials and program resources
- Marketing of the diabetes self-management program
- Support for existing community resources and relationships
- Assistance with data collection and analysis, and standards of diabetes care
- Assistance with obtaining accreditation for your diabetes program
- Guidance in preparing for the certified diabetes educator exam