Advertisement

Strategies for Improving Diabetes Care

This Physician’s Weekly feature was completed in cooperation with the experts at the American Diabetes Association. Over the last decade, healthcare providers in primary care settings and endocrinology practices have seen significant and steady improvements in the number of patients with diabetes who are achieving recommended levels of A1C, blood pressure (BP), and cholesterol. National data show that average A1C levels have declined from 7.82% in 1999-2000 to 7.18% in 2004, based on information collected in the National Health and Nutrition Examination Survey. Improvements in lipids and BP control have accompanied improvements in A1C, which in turn have led to substantial reductions in end-stage microvascular complications in individuals with diabetes. While these improvements are significant, data continue to suggest that there are areas for improvement in diabetes care. “Medications, technology, and enhanced insulin pens and pumps have had an important role in improving the management of diabetes,” says Martha M. Funnell, MS, RN, CDE. “However, some studies have shown that a substantial number of people with diabetes still have A1C, BP, and cholesterol levels that need to improve. Complicating the matter is that the quality of diabetes care varies considerably across providers and practice settings.” Examining Diabetes Intervention Over the years, researchers have implemented numerous interventions to improve adherence to recommended diabetes care standards, but care delivery systems are often fragmented and lack clinical information capabilities. In many cases, care delivery systems are poorly designed to manage this chronic disease. “Ideally, patients with chronic conditions like diabetes should be cared for by collaborative, multidisciplinary teams to facilitate self-management and self-care strategies for patients,” says Funnell. In the American Diabetes Association’s Standards of...

Weight Issues When Managing Diabetes

Patients with diabetes often struggle with being overweight or obese, and achieving or maintaining a healthy weight can be a serious and lifelong challenge for these individuals. Lifestyle modifications can improve glycemic control as well as body weight, blood pressure, and lipid profiles. However, behavioral changes are typically challenging and may require the help of others on the diabetes care team. Compounding the problem is that most patients will require multiple medications to manage their diabetes, and an unwanted side effect of some of these therapies is weight gain. This is often a special concern for many people with diabetes who are already overweight or obese. However, while there is the potential for weight gain, these medications are valuable treatments. When used properly, their benefits outweigh their risks. The Effect of Diabetes Therapies on Weight Research has shown that insulin, sulfonylureas, and thiazolidinediones may cause weight gain in some patients with diabetes. Weight gain with diabetes medications occurs for a number of reasons. When blood glucose levels are elevated, the excess glucose is excreted through the urine. With treatment, more glucose is available to be used by the body. Any glucose not used by the cells is stored as fat. As a result, patients who continue to consume the same number of calories may gain weight. The use of insulin and sulfonylureas may cause hypoglycemia, which needs to be treated with a fast-acting source of glucose, which can add calories. Thiazolidinediones can cause fat cells to store more fatty acids from the blood, causing those fat cells to enlarge. They can also lead to fluid retention, which may increase...
[ HIDE/SHOW ]