By Lamia Kadir, M.D.
Diabetes is a personal issue for me, as with many; my mother was diagnosed decades ago. I firmly believe a solid knowledge of diabetes is crucial for all primary care physicians. To know diabetes is to know medicine.
According to the American Diabetes Association, 25.8 million children and adults in the United States—8.3 percent of the population—have diabetes. There were 1.9 million new cases of diabetes diagnosed in people over age 20 in 2010.
Diabetes is the sixth leading cause of death in the United States and is the most common cause of preventable blindness, kidney failure and non-traumatic limb amputations. It is a major contributor to cardiovascular disease, the number one cause of death in this country. Although diabetes is not a true epidemic in that it does not spread from person to person, it is extremely prevalent and widespread. In all likelihood, many of your patients and your own family and friends may be affected by this epidemic.
As family physicians, we play a crucial role in screening for diabetes, providing treatment and counsel, and providing ongoing support to help our patients maintain a healthy lifestyle.
I invite all of you to visit the AAFP Foundation Highlight on Diabetes booth, No. 232, in the Exhibit Hall at TAFP’s 63rd Annual Session and Scientific Assembly next week. We will distribute free provider and patient handouts as well as healthy recipes you can share with your patients when you get back to the office.
Heading it Off: Screening as Prevention
The American Diabetes Association recommends that physicians screen for diabetes by monitoring a fasting blood sugar every three years, starting at age 45, and earlier and more frequent for those at higher risk, which includes the following.
- Are over age 45
- Have a family history of diabetes
- Are overweight or obese (BMI over 25)
- Have high cholesterol
- Have hypertension
- Identify with a high-risk ethnicity (African American, Hispanic, Pacific Islander, Asian American, and Native American)
- Have shown prior sugar elevation
- Are women with a history of gestational diabetes or who had a baby weighing 9 or more pounds at birth
- Show history or exam findings that are suspicious for the disease
Fortunately, we as family physicians can “predict” the emergence of diabetes and can delay the overt onset. It is widely known in the general health community that there are certain metabolic conditions that predict the onset of this lifelong disease. According to research, it is possible that if a pre-diabetic is not screened and interventions not made, 5-15 percent will convert from pre-diabetes to full diabetes every year.
As you know, first-line treatments of diabetes are lifestyle changes, such as dietary modification, exercise, and weight reduction. In addition to improving glycemic control, these changes in lifestyle also slow down progression towards developing diabetes in those who are at high risk.
However, diabetes is a progressive disease for which we have no cure. These measures over time are not usually enough to control blood sugar. All diabetics will eventually take medicine every day; pills, injections, or both. Many diabetics will need insulin to control their blood sugar; using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one.
Uncontrolled diabetic patients and those injecting insulin also have to regularly check their blood sugar by using a blood glucose monitoring system. Most diabetics also need medication to lower their blood pressure and cholesterol.
The American Diabetes Association provides a free online Diabetes Management Program (Diabetes 24/7), allowing patients to manage their Diabetes and share valuable health information with their health care team. Patients can track their blood glucose, blood pressure, physical activity, and weight.
What You Can Encourage Your Patients to do Now
- Make healthy food choices: Eat plenty of vegetables, choose fruit, whole grains, and low or non-fat dairy products. Limit the amount of meat and fried/fatty food. The American Diabetes Association has a user-friendly website. Encourage them to log on for free and sign up for MyFoodAdvisor, an online resource with recipes and cooking tips. Involve the whole family; you do not need to be a diabetic to eat healthy!
- Be active: Walk, garden, or do something moderately active for at least 150 minutes a week (average 30 minutes, five days a week)
- Stop smoking: It will literally save your life
- Lose weight using a combination of the above. A 5-10 percent weight loss yields a 58 percent reduction in the incidence of diabetes!
- Visit a family physician whom you trust and feel comfortable with. Get a yearly physical and ask about your risk for Diabetes.
References Used and Recommended
Lamia Kadir, M.D., is a board-certified family medicine physician practicing in Austin, Texas. She is a clinic leader for the national 2011-2012 GO! Diabetes initiative.