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Dementia Risk in Type 2 Diabetes: Assessing Racial & Ethnic Differences

Dementia Risk in Type 2 Diabetes: Assessing Racial & Ethnic Differences

Published research has shown that type 2 diabetes is associated with about a twofold greater risk of dementia among older adults, but it is unclear if the risk of dementia for people with diabetes varies across racial and ethnic groups. “Over the last 10 years, much has been learned about the connection between type 2 diabetes and dementia risk,” says Rachel A. Whitmer, PhD. “Rates of both of these conditions continue to rise as the population ages and as there continues to be growing ethnic diversity among older patients. Because type 2 diabetes increases the risk of dementia, it’s important to understand the risk of dementia among older adults with type 2 diabetes who are from diverse racial and ethnic backgrounds.” A national public health goal has been set forth to eliminate health disparities. This makes it increasingly important to understand racial and ethnic differences in diabetes-related complications, including dementia, among older adults. Studies have reported that the prevalence of dementia is higher among African Americans and Caribbean Hispanics, lower among Japanese Americans, and similar among Native Americans and Mexican Americans when compared with Caucasians. However, knowledge about racial and ethnic differences in dementia risk has not been thoroughly investigated among people with type 2 diabetes. Exploring Racial & Ethnic Differences In Diabetes Care, Dr. Whitmer and colleagues had a study published that examined if there are racial and ethnic differences in the 10-year incidence of dementia among individuals with type 2 diabetes. The study analyzed more than 22,000 culturally diverse patients with diabetes aged 60 and older who did not have preexisting dementia and were part of the...
Achieving A1C Goals: Back to the Basics

Achieving A1C Goals: Back to the Basics

Among the nearly 26 million Americans with diabetes, approximately half have not achieved an American Association of Clinical Endocrinologists (AACE)-recommended A1C goal of 6.5% or less. To address this issue, AACE and the American College of Endocrinology developed the Blood Sugar Basics: Get to Your Goals program. The program consists of an array of customizable tools and resources—available online and as hard copy materials—to encourage and empower patients with type 2 diabetes to know the importance of their A1C and work with their healthcare providers to set and achieve individualized blood sugar goals. A Helpful Resource Diabetes and its management can seem complex and overwhelming to patients, particularly for the newly diagnosed. “Patients need to understand that diabetes is a serious disease,” says Etie Moghissi, MD, FACP, FACE, the physician advisor for the Blood Sugar Basics program. “However, it’s important that they know that diabetes can be managed effectively when they’re engaged in their care.” To that end, the program—through its online home at www.bloodsugarbasics.com—provides downloadable checklists, tips for everyday management, videos, questions for patients to ask their providers, a quiz to test patients’ A1C knowledge, and more. In-depth information is provided on the importance of diet, exercise, medication (if prescribed), and monitoring and preventing symptoms. The resource also informs patients on hypoglycemia and how to avoid it. The resources fall under three overarching missions: 1. Gather intelligence. “The program provides recommendations for controlling A1C and setting specific goals so that patients can have informed discussions with their providers,” explains Dr. Moghissi. 2. Finalize a strategy. “Patients should know how to achieve their A1C goals with lifestyle changes and...
Getting Third Parties Out Of The Exam Room

Getting Third Parties Out Of The Exam Room

Any physician, especially primary care physicians, can tell you that they are frequently forced to make a decision based on a third party’s opinion. Most often, this will be an insurance company denying a prescribed medication or test; the discussion in the exam room evolves into a discussion of what is covered by the patient’s health plan—and what is not. The goal of providing the best medical care is often overruled by some of those decisions. Of course, the insurance company will tell you that they are not making medical decisions, and the patient can pay out of pocket if they would still like the medication or the diagnostic test. Most patients will chose to go with what their plan covers, either for financial reasons, or they feel they are paying an insurance premium, and their insurer should be paying for their medical care. All too often, I find myself playing the appeals game with the insurance companies in order to get appropriate care for my patients. For example, I recently saw a young asthmatic patient who was controlled on a certain inhaler for many years. They had tried others, but those had all failed to relieve the asthmatic symptoms. The insurance company decided that the patient would have to fail on a trial of one of the inhalers they had already failed on in the past before covering the current inhaler. Well, patients can end up in the ER or even die from an exacerbation of asthma. Clearly, this was not in the patient’s best interest. Why should third parties not be allowed in the exam room? *...
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