Diabetes: Another Poorly Managed Chronic Disease
Diabetes is dificult to manage, but we know that a person with diabetes needs to be educated, motivated, and diligent to succeed. Unfortunately, most people with diabetes do not enjoy a complete regimen of care, and don't know what they are missing.
Neither do most of their doctors and worse, the insurance system punishes (with inadequate compensation) efforts to provide comprehensive education, care, and support, while rewarding doctors who intervene to treat the complications of diabetes.
Diabetes is marked by problems in controlling blood sugar. People with diabetes who test their sugar several times a day can manage their food intake, exercise, and medications to better control the sugar. This can reduce the impact on fine blood vessels, and thus prevent blindness, nerve damage (leading to injury and amputation), and kidney failure. But this regimen can be expensive and the person with diabetes needs medical, social, and emotional support. And this help is needed during the person's daily routines, and not solely in a medical care setting. As people age, they tend to have multiple chronic diseases and have greater difficulty affording their medications.
But people with diabetes are also at risk for heart disease and death; many don't know the importance of managing cholesterol, blood pressure, and not smoking as essential to prevent heart disease.
Overweight is often seen as the "cause" of diabetes, but losing weight may not suffice to treat diabetes.
The New York Times is making a valiant effort at public education by reporting on "six killers" including diabetes. Ian Urbina, in a detailed report on how the system fails patients, says that "In the Treatment of Diabetes, Success Often Does Not Pay." Effective hospital-based programs work, but don't receive enough payment to continue. See nytimes.com/sixkillers
I think that new methods and systems are needed to implement what we know will work, but in a community setting, using any technology that will facilitate the program. The Chronic Disease Crisis: a white paper
Some useful information about diabetes can be found at government educational web sites.
Better Diabetes Care (CDC, NIH, NDDK)
http://www.betterdiabetescare.nih.gov/MAINintroduction.htm
Extended information to assist health care professionals develop patient-centered treatment programs.
Finding Information and Support (Agency for Healthcare Research and Quality )
http://www.ahrq.gov/consumer/diaginfo.htm
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Comments
Diabetes, anyone?
Nice summary, Jerry. I'm wondering: what's your connection to diabetes?
- AmyT of www.diabetesmine.com
Diabetes, the Chronic Disease
Amy, Thanks for your interest. I was a consultant for a company producing home test systems for diabetes (now sold by Johnson & Johnson). I thus became familiar with the public health impact of diabetes, and the fact that most people did not fully manage their condition (most did not test their blood sugar frequently enough.) Because blood sugar tests could generate a test result as a number, this seemed to make it easier for doctors and patients to evaluate the condition. Diabetes is a fairly advanced market and the poster child of chronic disease management.
In parallel, I have been involved in publishing patient handbooks for people living with Chronic Obstructive Pulmonary Disease (COPD) or sleep apnea. These books combined the insights and experiences of a person living with the condition, and the best current medical information. As much as these books were an important help to patients, I felt that a broader system was needed.
That led me to research the management of chronic disease, and of course much of that field is colored by the experience of diabetes. The commonalities among various chronic diseases: apnea, COPD, diabetes, and others should lead to a new model of care and treatment that enables patients to better manage their conditions. For an outline as I see it, please see: The Chronic Disease Crisis: a white paper
A report like that on diabetes by Ian Urbina in the N Y Times demonstrates a growing awareness of the limitations of our present methods, and encourages me to believe that change will become possible soon.
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