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April 1, 2009 > Hope and Help for Controlling Costly, Deadly Diabetes

Hope and Help for Controlling Costly, Deadly Diabetes

"In 2002, the Centers for Disease Control and Prevention (CDC) estimated the direct and indirect costs of diabetes in the United States at $132 billion," says Washington Hospital endocrinologist Dr. Prasad Katta. "Just five years later in 2007 (the latest year for which data are available), that figure had risen to $174 billion, surpassing the CDC's prediction of costs for 2010. Direct costs of treatment account for the lion's share of those costs at $116 billion, yet the indirect costs associated with premature death, disability, missed work days and lower productivity are substantial, too."

But the real cost of diabetes cannot be tallied in dollars and cents. Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. The CDC indicates, however, that diabetes is likely to be underreported as a contributing cause of death. Studies have found that only about 35 to 40 percent of people with diabetes had it listed anywhere on their death certificates. Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

Despite those grim statistics, Katta notes, there is hope - and help - for people with diabetes.

"Diabetes is actually not a difficult disease to treat," he says. "The key is to catch it early - even in the pre-diabetes stage - and then educate patients to really think about how they manage the disease. They need to think about monitoring their blood sugars. They need to think about the foods they eat. They need to think about getting plenty of exercise. And they need to think about taking their medications at the proper time and in the right dosage."

To help people learn more about diabetes and the latest options for prevention and treatment, Katta and Vida Reed, R.N., CDE, Washington Hospital's Diabetes Education Coordinator, will conduct a health and wellness seminar on Tuesday, April 14, from 1 to 3 p.m. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium, Rooms A & B, in the Washington West Building located at 2500 Mowry Avenue in Fremont. Call (800) 963-7070 to register.

Dr. Katta explains that there are two main types of diabetes:

* Type 1 diabetes most often appears in children or young adults. In this type, which accounts for only 5 to 10 percent of all cases of diabetes, the pancreas stops making insulin or makes only a tiny amount, so patients must inject insulin every day. Risk factors for Type 1 diabetes can include genetic and autoimmune disorders, as well as environmental causes.

* Type 2 diabetes, which is far more common, usually begins as insulin resistance, with the body's cells failing to use insulin effectively. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. In addition to a family history of diabetes, other risk factors for Type 2 include obesity and a sedentary lifestyle.

"Diabetes is usually diagnosed when the person's blood glucose level after fasting is over 126 mg/dL on at least two different occasions," Katta says. "Pre-diabetes, which is also called 'impaired fasting glucose,' is when the blood sugar level falls between normal and diabetic levels - 100 to 125 mg/dL. People with impaired fasting glucose are at an increased risk of developing diabetes and heart disease. Women with 'gestational' diabetes that first occurs during pregnancy and may disappear after the baby's birth have a higher lifetime risk of developing Type 2 diabetes, and their five-year risk is almost 50 percent."

In the past, the first line of treatment for diabetes was to improve the patient's diet and level of exercise and then re-evaluate the patient after three months. New guidelines now recommend adding medications right away to treat the condition more aggressively, but "self-care" measures still play a vital role.


Diabetes Management

"Washington Hospital's Diabetes Education Program works with patients to help them set and achieve their goals for diabetes management using the 'AADE7 Self-Care Behaviors' guidelines developed by the American Association of Diabetes Educators," Reed says. "We provide them with a 'diabetes care schedule' that outlines how frequently they should schedule screenings for their blood pressure, cholesterol levels and triglycerides, as well as dental, vision and foot exams. In addition, we offer a medical nutrition therapy program for patients with diabetes and other related health problems such as high cholesterol, high blood pressure and difficulty with weight management."

The AADE7 Self-Care Behaviors guidelines include:
* Healthy Eating - to control portion sizes and food choices.
* Being Active - to establish healthy, consistent exercise patterns.
* Monitoring - to keep track of your blood glucose level, blood pressure, cholesterol and other factors.
* Healthy Coping - to reduce stress factors that actually can raise blood sugar levels.
* Taking Medication - to ensure you take the proper dosages at the right time and discuss any concerns you have about side effects with your doctor before stopping medications.
* Problem Solving - to help you avoid problem situations that might arise when you attend a party, go out to dinner or face other self-care obstacles.
* Reducing Risks - to create a schedule of visits to your eye doctor, podiatrist, dentist and other health care professionals who can help you manage your risks for diabetes complications.

In addition to these self-care measures, there are several classes of medications available to treat diabetes. "Type 1 diabetes is caused by lack of insulin production, so people with Type 1 diabetes must take insulin injections every day," says Katta. "Insulin injections also can be used for people with Type 2 diabetes when they don't respond well to other medications."

At the upcoming seminar, Dr. Katta will discuss diabetes medications and how they can help manage the condition.

"In many cases, the patient's physician may prescribe more than one medication," Katta says. "I generally try to treat the problem aggressively using a combination of medicines. Within four to six weeks of beginning treatment, many of my patients are able to stop taking one or more of their medications. Again, the key is to start treatment early to help avoid serious complications later on."


Learn More About Diabetes

For information and referral assistance for the Washington Hospital Diabetes Education Program, call (510) 745-6556 or visit www.whhs.com/services/diabetes. To register for the Diabetes 1 & 2 seminar on Tuesday, April 14, please call (800) 963-7070.

For more information about the 7 Self-Care Behaviors, visit www.diabeteseducator.org and click on "Patient Resources" listed under "About Diabetes Education."

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