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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...
Is There A Mental Healthcare Crisis In The U.S.?

Is There A Mental Healthcare Crisis In The U.S.?

We are all shocked when we see news stories of multiple people being killed by someone who seems to have gone off the deep end. While these events are extremely rare, it is a true tragedy to have them happen at all. It is often found that the guilty parties were suffering from some mental illness. These are the extremes of mental illness. However, milder forms of mental illness, such as anxiety and depression are very prevalent in the U.S. The unfortunate reality is that for many of these patients, they just cannot get mental healthcare even if they want access to it. How big is the problem? According to a survey of physicians on Sermo, the number one social network exclusively for physicians, approximately 84% of the doctors polled believe there is a mental healthcare crisis in this country. Often times, the primary care physician is left to care for these patients whom they may not feel comfortable taking care of, just because they cannot get an appointment for the patient with a psychiatrist. I often times have a patient who I believe needs to see a psychiatrist but is unable to get an appointment for up to 6 months. If a patient is having a mental healthcare urgency, they usually end up in the ER for lack of access to outpatient healthcare. But, psychiatrists are not to blame. This is rather due to a broken system that is in need of major reforms. Why is there a mental healthcare access crisis in the U.S.? 1. In the 1960’s, psychiatric hospitals closed their doors, making inpatient services very...
Updated Guidelines for Assessing Cardiovascular Risk

Updated Guidelines for Assessing Cardiovascular Risk

Cardiovascular disease (CVD) caused by atherosclerosis continues to be the leading cause of death and is a major cause of disability as well as a significant source of healthcare costs in the United States. In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated clinical practice guideline to help clinicians better identify adults who may be at high risk for developing atherosclerotic CVD. The update, published jointly in the Journal of the American College of Cardiology and Circulation, also provides recommendations for identifying patients who could benefit from lifestyle changes or drug therapy to help prevent CVD. “These guidelines were last updated about 10 years ago,” says David C. Goff, Jr., MD, PhD, who co-chaired the ACC/AHA risk assessment guideline writing group. “Since that time, we have collected a large amount of research that has further enhanced our understanding of how best to care for these patients and improve our approaches to determining who should get specific types of preventive treatments.” Risk Assessment A key goal of the ACC/AHA guideline is to ensure that preventive treatments—especially lifestyle changes and drug treatment—are used in those who are most likely to benefit from them. To do this, the guideline includes high-quality risk assessment methods that use risk factors that are known to lead to atherosclerosis (Table 1). Factors such as age, cholesterol levels, blood pressure, smoking, and diabetes can be easily collected by clinicians and then integrated into a risk score to guide care and prompt discussions with patients.   “The vast majority of heart attacks and strokes could be prevented if patients knew...
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