Nearly one third of people with diabetes don't even know they have it.
That's a statistic that locally Madigan Army Medical Center's Diabetes Care Center hopes to lower, according to Sean Smith, the center's program coordinator.
They've been working with Madigan clinics, primarily Family Medicine and Internal Medicine, to put more emphasis on detection and prevention.
"We try to diagnose as early as possible," said Smith.
Part of this emphasis is focusing on patients who are at risk for developing diabetes, screening for family history, weight, diet, activity levels, age (risk increases after age 40), and more. They're placing particular emphasis on screening for patients with prediabetes (those with glucose levels between 100 and 126), sending them to dieticians, and as needed prescribing oral medications to reduce their glucose levels.
Just as worrying for the Diabetes Care Center as undiagnosed diabetes patients are those patients already diagnosed with diabetes who aren't being seen regularly to help manage it. In 2013, the center saw about 2200 patients, although Madigan has more than 4000 patients diagnosed with diabetes.
"One of the problems that we have though is most people don't feel sick with diabetes. It's one of those hidden diseases," said Smith. However, he said that diabetes has a very serious potential for negative outcomes, to include increased risk for cardiovascular disease, stroke, infection, and other complications like neuropathy, blindness, and kidney failure.
"The problem is until a lot of that damage happens, most people feel just fine," said Smith. Smith emphasized that they put an individualized focus on diabetes management since outcomes can be completely different for each patient. Unlike many other diseases, patients with very similar circumstances can require very different forms of disease management, ranging from changes in diet and exercise alone to requiring oral medication or insulin.
Smith and his team know that being diagnosed with a chronic disease can be challenging, and they purposely steer their approach to focus on what patients are doing well in managing their diabetes and what their goals are. They work closely with patients to seek out what motivates them to be healthy, to problem solve with them and identify coping skills.
"We are coming up with goals that are patient goals, not goals that we like to see the patient have," Smith said, noting that they work to break down goals into small steps and celebrate when each one is accomplished.
The Diabetes Care Center also offers several group educational classes for diabetes patients, to include classes on an introduction to diabetes, nutrition, insulin tips, medication management, and learning to live with a chronic disease. Their bimonthly Forum is patient-led, with discussion topics chosen by patients. Smith describes it as an opportunity for patients to learn from each other, to include what's working and what's not in managing their illnesses. "They can talk openly about some of their struggles. It's very non-threatening," he said.
The center is helping to bring diabetes education directly to Family Medicine patients by advising the department on the development of its "Diabetes Birth Month Annual Review" program, which began in September. The Diabetes BMAR invites diabetic patients to attend a two-hour interactive class during their birth months that allows patients to form action plans though discussions with pharmacists, diabetic educators, optometrists, nutritionists, behavioral health providers and nurse case managers, said Lesa Tweet, a Department of Family Medicine nurse case manager. The class also focuses on hand and foot checks, blood pressure checks, reviewing and updating labs and medications, flu shots, and retina eye exams.
The Diabetes BMAR sessions have also resulted in identifying some patients who require follow-up appointments to evaluate their current therapy or for education in self-management of diabetes, said George Dydek, a clinical pharmacist with Family Medicine.
Smith lauded that the class brought in some lost follow-up patients -- those with diabetes who failed to complete follow-on care.
"Diabetes in the past has had a stigma attached to the word, and we are trying to take that stigma away. Early detection, early prevention will result in better outcomes overall for our patients," said Smith.
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