November 2011 is Diabetes Awareness Month
More than Half of All Americans Will Have Diabetes by 2020 – Ranks Could Swell to 135 millionHalf of all American adults are destined to develop diabetes or pre-diabetes by 2020 if they don't make dramatic lifestyle changes, according to a dire new prediction from the Centers for Disease Control and Prevention. If current trends continue, the ranks of American adults with excessive blood sugar levels would swell from 93.8 million this year (about 28 million diabetics and 66 million more with pre-diabetes) to 135 million in 2020 – and cost society $3.35 billion by decade’s end. In addition, diabetes is becoming one of the most common chronic diseases in children and adolescents. According to the American Diabetes Association, one in every four children is currently diagnosed with diabetes. Dr. Joel Zonszein believes that unless people improve their diet and exercise more regularly, diabetes could become an epidemic of tsunami-like proportions.Joel Zonszein, MD, CDE, FACE, FACPDirector, Clinical Diabetes Center, Weiler, Professor of Clinical Medicine, Albert Einstein College of Medicine
American Diabetes Association Recommends Popular Diabetes Drug Metformin to Treat Pre-diabetesPre-diabetes, which affects an estimated 79 million Americans, has been termed "America's Largest Healthcare Epidemic.” The Diabetes Prevention Program (DPP), a study published in The New England Journal of Medicine by scientists at Montefiore and Albert Einstein College of Medicine, found that metformin, the drug typically used to treat diabetes, combined with lifestyle changes, can effectively delay the onset of diabetes. As a result of these findings, the American Diabetes Association now recommends use of this medication for treating pre-diabetes. The condition is diagnosed in patients when blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes, placing people at high risk for diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. Joel Zonszein, MD, CDE, FACE, FACPDirector, Clinical Diabetes Center, Weiler, Professor of Clinical Medicine, Albert Einstein College of Medicine
Disease Management Program Improves Outcomes The Bronx has one of the largest, highest-risk and most difficult-to-treat populations of diabetes patients in the city and the nation. Through a care-management program called the CMO, or Care Management Organization, Montefiore Medical Center has found a way to improve outcomes in Type 2 diabetes patients in a low income, urban setting. In fact, A1c glucose levels in 1,000 patients have been successfully reduced by 16 percent from 2008 to 2009, while at the same time reducing healthcare costs and decreasing hospital re-admissions by 16 percent. Six certified Diabetes educators (CDEs) actively manage patients through telemedicine and electronic medical records, as well as on-going education and support by a team of professionals that augment a patient’s relationship with their physician. A patient’s blood sugar levels are sent each day to a care management nurse – if their A1c levels get too high, the patient receives a phone call to determine the need for a medical intervention. -Jon Swartz, MD, MBA, FAAFP, Internist, Care Management Organization (CMO) -Sandra Barnaby, RN, MPH, Chronic Disease Mgr.
Education is Key in Fighting DiabetesWith the guidance of Nurse Practitioner Sheila Felleman, free interactive diabetes workshops meet monthly throughout the Bronx and lower Westchester to help educate patients how to manage living with diabetes. These classes are led by RNs and LPNs who are Certified Diabetes Educators and are offered in both English and Spanish. They discuss, in a culturally sensitive way, proper foods, myths and facts and maintaining glucose levels. They look at an actual map of a sample neighborhood and “visit” food markets, discuss the right foods to buy and then go over specific recipes that are popular with a variety of populations. These groups, provided by the Care Management Company (CMO) of Montefiore, are open to everyone. Sheila Felleman, RN, MPA, Director of Chronic Care, Montefiore Medical Center Care Management Organization (CMO)
Simple Blood Test to Determine Blood Sugar LevelHemoglobin A1c provides an average of the blood sugar control over a six to 12 week period and is used in conjunction with home blood sugar monitoring to make adjustments in diabetes medicine dosages. For people without diabetes, the normal range for the hemoglobin A1c test is between 4-6 percent. Anything higher than that may result in the development of complications from the disease. This test is so highly thought of, that Montefiore Medical Center now offers it to all employees who are high risk for the disease. Risk factors include obesity, high blood pressure and high cholesterol.Rita Louard, MD, Director, Clinical Diabetes Center, Moses, Associate Professor of Clinical Medicine, Albert Einstein College of Medicine
Diabetes Emerges as a Growing Health Issue for Both Mothers and BabiesApproximately 3-5 percent of pregnant women suffer from gestational diabetes, which is defined as diabetes during pregnancy. Many women don’t even know they have type 2 diabetes until they begin seeing their doctor during pregnancy. A recent international study, Hypoglycemia and Adverse Pregnancy Outcome (HAPO), indicated that higher maternal glucose levels are associated with higher rates of adverse obstetrical outcomes, which include risk of miscarriage, urinary tract infections, dental disease and poor wound healing. Pre-diabetes also can have profound long term effects on the newborn baby, by altering metabolism and increasing its risk for developing diabetes and heart disease. In fact, 6-7 percent of women will be diagnosed with type 2 diabetes immediately after delivery, while 30 percent will develop the condition within 10 years. However, there is hope -- pregnant women are a relatively captive audience and are often more open to education. It also gives health care professionals an opportunity to counsel the entire family since diabetes management and treatment is relatively similar for all adults. It initially begins with lifestyle changes focusing on physical activity, food choices and portion control. As needed, additional medical interventions to lower glucose values are prescribed. This involves the use of glucose lowering drugs, hypoglycemic agents. During pregnancy, they are generally limited to oral agents, such as glyburide and metformin or injectable insulin.Cassandra Henderson, MD, CDEOb/Gyn and Certified Diabetic Educator, Department of Obstetrics & Gynecology and Women’s Health, Division of Maternal-Fetal MedicineAssociate Professor, Albert Einstein College of Medicine
Montefiore Medical CenterAs the University Hospital for Albert Einstein College of Medicine, Montefiore is a premier academic medical center nationally renowned for its clinical excellence and scientific discovery; compassionate, patient-centered model of care; commitment to its community; and medical education, including the second largest residency program in the country. Montefiore is recognized among the top hospitals nationally and 6th out 180 in the New York metro area by U.S. News & World Report. The Children’s Hospital at Montefiore has consistently ranked in U.S. News “Americas Best Children’s Hospitals,” and is 2nd among those in the New York metro area. As an integrated health system, it is comprised of four hospitals, has nearly 1,500 beds and over 93,000 annual hospital discharges, and is seamlessly linked by advanced technology. State-of-the-art primary and specialty care is provided through a network of nearly 100 locations across the region, including the largest school health program in the nation and a home health program. Inspired by its patients and its community, Montefiore is on the frontlines of developing innovative approaches to care and is a national model for excellence.
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