Local and National News & Notes
The 2007 National Diabetes Fact Sheet (latest statistics available) notes 7.8 percent of the U.S. population is diabetic and more than twice that number are classified as pre-diabetic. There were 17.9 million diagnosed cases in 2007 with another 5.7 million undiagnosed. Nearly 57 million Americans are considered pre-diabetic, and 1.6 million cases of diabetes are diagnosed in people aged 20 and older every year. Prevalence rates increase with age. Under 20 years of age, about 0.22 percent of the population has diabetes; 10.7 percent of adults age 20 and older have diabetes; and 23.1 percent of all Americans in the age group of 60 and older are diabetic.
A national health problem, diabetes is especially troublesome in Tennessee. The state ranks sixth highest in the nation for the ratio of people with diabetes to the general population. By 2007, 11.9 percent of Tennessee’s total adult population had been diagnosed with diabetes. More recent numbers indicate the state might be seeing a slight decline in prevalence. The 2008 Behavioral Risk Factor Surveillance System survey found 10.3 percent of Tennessee respondents answered, “yes,” when asked if they had ever been diagnosed as having diabetes by a health provider. The 1.6 percent drop, however, is within the statistical margin of error. Still, Tennessee Health Commissioner Susan R. Cooper, MSN, RN, called such findings encouraging, and noted, “Reducing rates of diabetes will go a long way in improving Tennessee’s overall health status.”
Oral Meds Up, Insulin Down According to AHRQ
The proportion of Americans reporting treatment for diabetes who took oral medications to treat their condition increased from 60 percent in 1997 to 77 percent in 2007 – a 28 percent increase – according to the latest information from the Agency for Healthcare Research and Quality, which was released in late September. During the same period, the proportion taking insulin to control their diabetes fell from 38 percent to 24 percent.
The federal agency’s analysis also revealed a shift in the three most commonly prescribed oral medications between 1997 and 2007. The proportion of Americans using sulfonylureas – which stimulate the pancreas to produce more insulin – declined from 1997 to 2007 (51 percent down to 40 percent). The proportions using biguanides – which reduce the liver’s excess glucose production – and thiazolidinediones – which increase insulin sensitivity – rose during the period (21 percent to 55 percent and 5 percent to 25 percent, respectively). More information is available in “Trends in the Pharmaceutical Treatment of Diabetes: A Comparison of Utilization and Expenditures, 1997 and 2007,” through AHRQ’s Medical Expenditure Panel Survey (MEPS) site at www.meps.ahrq.gov.
Diabetes Alerts from Baptist & MTMC
Diabetes-related emergencies have been mistaken for drunk driving incidences in the past. To combat this misperception and alert law enforcement officers and first-responders that a driver might be experiencing a hypoglycemic or hyperglycemic event, the Diabetes Centers at Baptist Hospital and Middle Tennessee Medical Center recently launched Diabetes Alert, which includes a sticker placed on the driver’s side rear window.
The initiative was developed in collaboration with area law enforcement agencies and is designed to help officers better identify symptoms associated with a diabetic event in order to take appropriate measures. Health officials have provided area law enforcement officers with education to increase their awareness about diabetes complications, and emergency medical responders have also been made aware of the Diabetes Alert initiative to facilitate prompt treatment.
“Patients have reported incidences of having a low or high blood sugar episode while driving and being pulled over by law enforcement,” said Mary Gaines, program director for the Diabetes Centers. She added the patients reported being mistakenly identified as driving under the influence, keeping them from receiving necessary assistance. “Appropriate treatment in a timely manner is crucial,” Gaines continued.
The Diabetes Alert program is a free service and is available to anyone in Middle Tennessee who has been diagnosed with diabetes. To participate, a patient can obtain a pre-printed Diabetes Alert prescription from their personal physician, who does not have to be affiliated with Saint Thomas Health Services. A downloadable prescription form is available online at either www.baptisthospital.com/diabetes or www.mtmc.org/diabetes. The patient should then take the prescription to either Baptist Hospital or Middle Tennessee Medical Center Diabetes Centers or to Saint Thomas Health Services Community Medicine on Hayes Street to receive the car sticker and a copy of the prescription form to be kept with their automobile registration.
Wellmont Health System and Mountain States Health Alliance are also participating in East Tennessee.
A Life of Control: New Book from Vanderbilt Press
Scheduled for official release this month by Vanderbilt University Press, Alan Graber, MD, Anne W. Brown, RN, MSN, and Kathleen Wolff, RN, MSN, have co-authored a book about the daily struggle of living with diabetes. The colleagues, who worked together for 25 years in private practice at Saint Thomas and later at the Vanderbilt Eskind Diabetes Center, wrote “A Life of Control: Stories of Living with Diabetes” to shine a spotlight on the day-to-day realities and strategies that diabetes imposes on those with the disease and on healthcare providers who constantly struggle to mitigate its toll on patients.
Graber, an endocrinologist who retired in 2006, spent hours … and sometimes a full day … interviewing diabetics about how the disease had influenced their lives, and how their lives impacted the course of diabetes.
“The premise of the book became diabetes occurs in a life that already has a story of its own,” he said. In interviewing former patients he began to truly see them as people rather than as a clinical problem to resolve. Brown and Wolff added their own perspectives, which Graber called more holistic in comparison to his analytical viewpoint, as the team worked together to write and edit the book. At its completion, the project included nearly 40 personal narratives of living with diabetes.
“A Life of Control” is divided into four distinct components: how a patient’s life and personality influenced the cycle of the disease; the effect diabetes has on a family; the social context in which the diabetic lives their life; and the clinician/patient relationship. Some of the stories told include that of Rosa, a registered nurse who practices “diabulimia” — omitting insulin to try to lose weight — over the protests of her physician, and Jeff, who must go into “warrior mode” on a regular basis when dealing with his employer-sponsored health plan.
In addition to the narratives, the book includes material on prevention, complications and new technology. Meant neither as a textbook or a self-management guide, at its core the book is written to provide insight into living with diabetes.
“I think if I’d written this book 30 years earlier, I would have been a better doctor because it gave me a different perspective than my formal medical training,” Graber concluded.
With nearly 18 million Americans diagnosed with diabetes, a large … and growing … market exists for products to help effectively manage or simplify living with the chronic disease. Overton Enterprises has introduced the Diabetic SPIbelt™ to help safely stow insulin pumps and supplies while maintaining an active lifestyle. SPIbelt, an acronym for “Small Personal Item Belt,” was launched in 2007 after developer Kim Overton grew frustrated trying to keep up with her key while running. Although the original SPIbelt was created for athletes, the newer version was designed to hold emergency medical items including pumps and asthma inhalers.
Worn around the waist, the Diabetic SPIbelt helps keep cumbersome items like insulin pumps and medications stable and easily accessible while keeping hands free to enjoy activities. “Our new Diabetic SPIbelt not only has an opening for the insulin tube, but it still serves the original purpose of holding small personal items such as epi-pens, other medications, car keys, identification or iPods,” Overton said. As part of the company’s partnership with Triabetes, a USAT-certified triathlon club for participants of all ages with diabetes, Overton Enterprises donates $1 of every sale from its original black SPIbelt with a bright orange zipper to the organization.
On the high tech end, MyGlucoHealth meter is the first FDA-cleared Bluetooth blood glucose monitor. The device by California-based Entra Health Systems, manages communications between patient, clinicians and personal caregivers. It securely transmits readings to a private personal health record on the Internet via a mobile phone or personal computer. In addition to medication reminders for patients, the device can also send automated e-mails or text message alerts to clinicians, family members or caregivers. Physicians have the ability to quickly download data to analyze results, and users have access to online personal healthcare logs to track diet, medication, exercise, cholesterol and blood pressure.
“The Patient Portal is engineered to help persons with diabetes take ownership of their disease management so they can make better lifestyle choices,” said Larry Mahar, chief technology officer of Entra Health Systems. “We are constantly improving and expanding our web technology to provide more comprehensive tools for our patients. We added features like blood pressure recording, since hypertension is an important risk factor for the development and worsening of many of the complications of diabetes.”