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Preventing Complications of Diabetes

Preventing Complications of Diabetes

More than 29 million Americans have diabetes, and the disease ranks as the seventh leading cause of death in the United States. About 86 million adults in the U.S. have prediabetes, but structured lifestyle-change programs have been shown to help prevent or delay type 2 diabetes by 60%. Although encouraging, the task of preventing complications in patients diagnosed with type 2 diabetes can be challenging because these individuals often do not qualify for enrollment into diabetes prevention programs. With type 2 diabetes, several types of complications can occur over time, including coronary heart disease, cerebrovascular disease, retinopathy, nephropathy, and neuropathy, among others. Many of these complications produce no symptoms during the early stages of diabetes, but most can be prevented or minimized with a combination of regular medical care and blood sugar monitoring. “Even after patients are diagnosed with type 2 diabetes, clinicians should make efforts to ensure that other prevention strategies are initiated and used throughout follow-up,” says John B. Buse, MD, PhD. Guide Patients to Interventions It is critically important that physicians recommend lifestyle interventions to patients who are diagnosed with type 2 diabetes, according to Dr. Buse. The American Diabetes Association has released toolkits for clinicians that are intended for use with their patients, including segments on optimizing care of the disease (Table 1) and preventing cardiovascular complications (Table 2), among several others. Dr. Buse says these resources and others can be especially helpful when having discussions with patients about what they will need to do to prevent diabetes-related complications. Clinical guidelines recommend screening patients for prediabetes early in order to prevent progression to type 2...
Depression & Mortality in Older Diabetics

Depression & Mortality in Older Diabetics

Data indicate that patients with diabetes have almost double the risk of being depressed, when compared with those with­out the disease. Studies have assessed the link between depression and mortality among patients with diabetes, but the role of age in this association is still being explored. Studying the Association For a study published in the Journal of the American Geriatrics Society, Carol M. Mangione, MD, MSPH, and colleagues assessed the relationship between depression and long-term mortality among more than 3,000 patients with diabetes. Patients were divided into those aged 65 and older and those younger than 65. “It’s well known in geriatrics that people older than 65 often have less typical presentations of depression, so it can be easily missed,” says Dr. Mangione. “We felt there may be fewer depression cases diagnosed in older patients. In addition, since other investigations have shown that older patients are less likely to get treated for depression, we hypothesized that the impact of having diabetes and depression would be greater among older adults.” The study team’s findings confirmed their suspicions. The risk for early mortality among depressed patients with diabetes was 49% higher than that of counterparts without depression. However, depressed patients aged 65 and older with diabetes had a 78% higher mortality risk than non-depressed diabetics in the same age group. “There was a trend toward higher mortality among younger diabetics with depression when compared with diabetics without depression in the same age group, but it was not statistically significant,” adds Dr. Mangione. Putting Findings Into Practice According to Dr. Mangione, the associations observed in the study should send a message to...
Transformative Leadership Begins with Self-Development

Transformative Leadership Begins with Self-Development

If healthcare leaders want to transform our healthcare system so it is truly patient-centered and cost-effective and if we are serious about creating a culture of health in which we are preventing diseases long before they result in sickness, the place to start is with ourselves. All healthcare leaders—no matter whether you practice in a small office or a large hospital—because more often than not, physicians set the tone. But what you may not realize is that your mental and emotional state has a significant effect on the people around you. In his book Primal Leadership: Unleashing the Power of Emotional Intelligence, psychologist Daniel Goleman revealed: “The actions of the leader account for up to 70 percent of employees’ perception of the climate of their organization.”[1] Leading Means Showing the Way Unhappy, dysfunctional leaders cannot create high-functioning, compassionate practice environments, and a stressed out, unhealthy organization cannot take care of the health of others. So as physicians, we need to ensure that the effect we have on others is positive and beneficial. As leaders: ♦ If, when facing a problem, we display thoughtful intelligence rather than anger or frustration, we will inspire that behavior in others and promote creative solutions. ♦ If we are trustworthy and nurture a culture of trust, our colleagues will feel safe enough to communicate honestly, therein creating an environment in which real change is possible. ♦ If our words and actions demonstrate a deep commitment to cost effective, patient care, others will follow our lead, resulting in an improved practice environment. ♦ If we hold ourselves accountable for the vision and if we foster...
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