Friday, February 22, 2008

Diabetes: latest studies: four ways to charge now

An estimated 14.6 million people in America, or seven percent of the population, have diabetes, primarily Type 2, reports the American Diabetes Association. Here is a look at three recent study findings that highlight how diabetes care can be improved by both caregivers and patients themselves.



A recent study in the Archives of Internal Medicine reported that some obstacles to self-monitoring include discomfort, inconvenience, cost, difficulty doing so, and fear of "bad" results.


To address these issues, researchers divided 199 patients with Type 1 or Type 2 diabetes into three groups. One group was given an 18-page color manual describing therapies, the mechanics of glucose monitoring and strategies for dealing with feelings about diabetes and blood glucose monitoring. Another group was given a glucose meter only, and a third group received usual care.


Patients in the first two groups also had a 30-minute diabetes education session. At the end of six months, patients who had received the manual were checking their glucose levels much more frequently that those in the other two groups. People with Type 1 diabetes were checking their levels an average of 3.5 times daily and those with Type 2, an average of 2.3 times per day.



Fewer than half of adults diagnosed with diabetes get the three recommended yearly medical tests they need to manage their disease, the federal Agency for Healthcare Research and Quality (AHRQ) recently reported. An agency panel found that just 41.7 percent of people with diabetes had checkups during the past year for blood sugar levels, diabetic retinopathy or other diabetes-related eye damage, foot sores and foot irritation.


Only 50.1 percent said they had had one or two of the exams and 3.6 percent had no idea if they had had one. The AHRQ estimates that improved primary care could prevent some $2.5 billion per year in hospital costs caused by complications of diabetes.



A University of Michigan (Ann Arbor) study found that only 43 percent of people age 55 and older who have diabetes get medicines that could protect their heart and kidneys. Risk of heart and kidney disease are dramatically increased in people with diabetes. Both angiotensin-converting enzyme inhibitors (ACE) and angiotensin-receptor blockers (ARB) lower cardiovascular risk and are recommended for nearly every older person with diabetes. But after surveying 742 people with diabetes as part of the 1999 to 2002 National Health and Nutrition Examination Survey, researchers say national rates of medication use are "disturbingly low." People with hypertension were most likely to take an ACE or ARB medication; those with kidney dysfunction or disease, or cardiovascular disease, were not. The more conditions a person had the greater the likelihood he or she would take a drug. Even so, only 53 percent of people with four or more indications for ACE or ARB use took a drug.



In a recent clinical review published in the Journal of the American Medical Association, researchers at Johns Hopkins University School of Medicine stressed that using two methods to gauge blood glucose levels is more effective than one alone. The reviewers recommend that self-monitoring of blood glucose levels, the foundation of diabetes management, be encouraged, especially in patients who use insulin. The frequency and timing of the test should depend on the patient.



Measurements of hemoglobin A1c values, which show a patient how his or her blood glucose levels are doing over a certain period of time, should be taken by a physician every six to nine months to assess the success of the treatment regimen, say the researchers.