Diabetes
The rates of people with diabetes in the United States continue to grow dramatically each year. In 2002, the Centers for Disease Control (CDC) reported that 18.2 million people have diabetes with 1.3 million new cases diagnosed each year. An estimated 13 million have been diagnosed with diabetes, while 5.2 million people are unaware that they have the disease. The U.S. Department of Health and Human Services (HHS) is pursuing three goals designed to reverse this disturbing trend: preventing, curing and improving the quality of care for people with diabetes to prevent devastating complications.
"Diabetes can lead to serious health complications including heart disease, blindness, kidney failure and lower-extremity amputations. |
People with type 1 diabetes, often referred to as juvenile-onset diabetes account for up to 10 percent of all diabetic cases. People with adult onset type 2 diabetes account for the remaining 90 percent of those diagnosed. Risk factors for people developing type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians and some Asian Americans and Pacific Islanders are at a particularly high risk for the development of type 2 diabetes.
People who think they have diabetes might have some or none of the following symptoms, according to the CDC:
- Frequent urination
- Excessive thirst
- Unexplained weight loss
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in the hands or feet
- Feeling very tired much of the time
- Very dry skin
- Sores that are slow to heal
- More infections than usual
Diabetes can lead to serious health complications including heart disease, blindness, kidney failure and lower-extremity amputations. Diabetes is the sixth leading cause of death in the United States. The CDC reported that the estimated cost of diabetes in 2002 was $132 billion. Of this amount, $92 billion was due to direct medical costs and $40 billion was due to indirect costs such as lost workdays, restricted activity and disability due to diabetes.
Preventing and Curing
While HHS would like to see the number of people with diabetes declining, only significant lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. Maintaining a healthy weight, eating nutritious meals and regularly exercising can sometimes prevent type 2 diabetes from developing.
The most ambitious of HHS goals, curing diabetes, involves research into pancreas transplantation, Islet cell transplantation, artificial pancreas development and genetic manipulation. While these progressive goals are in motion, the home medical equipment industry focuses primarily on disease management — assisting people with diabetes by providing products aimed at monitoring and improving their quality of care.
Improving Quality of Care
People with diabetes need to work closely with their health care provider to monitor their diabetes and learn to manage it. Since many people with diabetes have multiple conditions, HME providers can establish relationships with physicians as well as many specialty health care providers as referral sources. People with diabetes may see endocrinologists who specialize in diabetes care, opthalmologists for eye examinations; podiatrists for routine foot care and dieticians and diabetes educators who teach the skills needed for diabetes management. As people with type 2 diabetes are diagnosed, many are referred by their physicians to participate in a diabetes management program.
Checklist for Consumers
Aleda Keel, R.N. and diabetes education coordinator, Dallas, provided education for people with diabetes in a six-week diabetes management program. The program involves one-on-one sessions with a newly diagnosed patient, group classes, meetings with a nutritionist as well as six months of monitoring the patient after the six-week program ended. "We explain the use of their blood glucose meter, what the readings mean, what affects their blood sugar level, exercise programs, different classes of medication, how to take it, what happens if you miss it."
Keel explained that many nurses develop preferences for certain types of blood glucose monitors recommended by dealers and they pass along those specific recommendations to their patients. Keel said that patients who are required to test their blood glucose levels frequently — multiple times a day — often look for blood glucose monitors with alternate site testing, where testing can take place in the forearm, thigh, calf and palm, in addition to fingertips.
"A lot of it depends on the patient. You may have someone who thinks testing on the fingertips is not a big deal, while others will complain of the sensitivity in their fingertips," Keel said.
Some people with diabetes may need lancets with adjustable depths, depending on the pads on their fingertips and whether their fingertips have calluses. Many manufacturers are developing diabetes products designed to be pain free, accurate, fast, easy to use and reliable.
Reducing the potential complications of diabetes can prevent hospitalization and reduce costs. Controlling levels of blood glucose, blood pressure and blood lipids are three of the primary steps in preventative care. Blood glucose readings help people with diabetics to gauge how they are doing; blood pressure control can reduce the incidence of cardiovascular disease and control of cholesterol or blood lipids can reduce cardiovascular complications as well.
People diagnosed with type 2 diabetes, usually have higher rates of cholesterol and triglyceride abnormalities, obesity and high blood pressure. Many people with type 2 diabetes have several of these conditions at the same time. According to the CDC, the combination of all of these problems is often called the metabolic syndrome. The metabolic syndrome is often defined as:
- excess around the waist
- high levels of triglycerides
- low levels of HDL, or good cholesterol
- high blood pressure
- high fasting blood glucose levels
For people with diabetes to maintain heart health, the CDC recommends the following tips:
- Eat right.
- Get physical activity.
- Don't smoke.
- Check and maintain healthy blood glucose.
- Check and maintain healthy blood pressure.
- Check and maintain cholesterol levels regularly.
- Try to lose weight if overweight.
- Work with a dietician to develop a healthy meal plan.
- Get a hemoglobin A1C test twice a year to determine your average blood/glucose level for the past two to three months.
- Take medications when prescribed by a doctor.
Blood pressure and blood glucose monitoring are essential for heart health. High blood glucose for a prolonged period of time can damage the blood vessels that bring oxygen to some nerves, as well as nerve coverings. Damaged nerves can result in numbness, pain and weakness in the hands, arms, feel and legs.
The National Diabetes Information Clearinghouse conducted studies that showed that keeping blood glucose levels close to normal helps prevent type 1 diabetes-related complications, lowering incidents of diabetic eye, kidney and nerve complications.
Resources
A nutritious diet, regular physical activity and insulin injections are the basic therapies for type 1 diabetes and a nutritious diet, regular physical activity and blood glucose testing are the therapies for people with type 2 diabetes.
Technology has improved the lives of diabetics with quick- and longer-acting insulins for people who are insulin dependent. More oral drugs are available for people with type 2 diabetes. New monitors make it easier and more comfortable for people to test and track their blood.
Reimbursement
Although reimbursement cuts resulting from the Medicare Modernization Act have affected diabetic supplies, these products are life-saving tools that will continue to be in high demand as consumers seek a better quality of life. Product compliance has the potential to dramatically improve the health outcomes of people with diabetes.
Diabetes Products
Checklist for Consumers
According to the medical journal Diabetes Care, when people with diabetes wear double-layer socks, it can help to reduce in-shoe pressure on the underside of the foot. Special socks can assist people with nerve damage related to diabetes. Altering the kind of socks can be an inexpensive method of protecting at-risk feet.
The CDC recommends the following tips for people with diabetes to protect their feet:
- Look for cuts, cracks, sores, red spots, swelling, infected toenails, splinters, blisters, and calluses on the feet each day. Call your doctor if such wounds do not heal after one day.
- If you have corns and calluses, ask your doctor or podiatrist about the best way to care for them.
- Wash your feet in warm — not hot — water and dry them well.
- Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
- Rub lotion on the tops and bottoms of feet — but not between the toes — to prevent cracking and drying.
- Wear shoes that fit well. Break in new shoes slowly, by wearing them one to two hours each day for the first one to two weeks.
- Wear stockings or socks to avoid blisters and sores.
- Wear clean, lightly padded socks that fit well; seamless socks are best.
- Always wear shoes or slippers, because when you are barefoot it is easy to step on something and hurt your feet.
- Protect your feet from extreme heat and cold.
- When sitting, keep the blood flowing to your lower limbs by propping your feet up and moving your toes and ankles for a few minutes at a time.
- Avoid smoking, which reduces blood flow to the feet.
- Keep your blood sugar, blood pressure, and cholesterol under control by eating healthy foods, staying active, and taking your diabetes medicines.
Resources
Indian Health Service
Diabetes Program
http://www.ihs.gov/MedicalPrograms/Diabetes/index.asp
National Diabetes Education Program
http://www.cdc.gov/diabetes/ndep.index.htm
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov
National Eye Institute
http://www.nei.nih.gov
Office of Minority Health Resource Center
http://www.omhrc.gov
American Association of Diabetes Educators
http://www.aadenet.org
American Diabetes Association
http://www.diabetes.org
American Dietetic Association
http://www.eatright.org
American Heart Association National Center
http://www.americanheart.org
American Optometric Association
http://www.aoanet.org
American Podiatric Medical Association
http://www.apma.org
Juvenile Diabetes Research Foundation
http://www.jdrf.org
Diabetes Products
Blood Glucose Meter
The QuickTek® blood glucose meter from Hypoguard USA Inc. is a full-featured meter for diabetes management.
Blood Pressure Monitor
The UA-704 Mini Manual Inflate from A & D Medical is a handheld blood pressure monitor designed to perform approximately 2,000 measurements on a single AA battery.
Insoles
Atlantic Footcare's therapeutic standard and therapeutic wide insoles are pre-engineered orthoses designed and developed to meet the needs of people with diabetes.
Skin Therapy
The Borage Dry Skin Therapy® foot cream from Shikai Products is made from Borage oil and is formulated to help those who suffer from diabetes.
This article originally appeared in the October 2005 issue of HME Business.