Nearly 10 percent of the U.S. population has diabetes, including millions who are un-diagnosed. An estimted one in four U.S. adults are unaware they have “prediabetes” — when blood sugar levels are higher than normal, but not high enough to be considered diabetes.
An updated U.S. government report — Guiding Principles for the Care of People With or at Risk for Diabetes [1] — finds troubling trends in the management of diabetes in adults already diagnosed with the chronic condition that can be life-threatening if untreated. Diabetes can increase the risk of cardiovascular disease, cancer and dementia.
The new report was produced by the National Diabetes Education Program (NDEP), a federally funded program sponsored by a division of the U.S. Department of Health and Human Services — the National Institute of Diabetes and Digestive and Kidney Diseases (NIDKK). The U.S. Centers for Disease Control and Prevention (CDC) is also a sponsor of the program.
Diabetes management is “suboptimal,” particularly in disproportionately affected poor and minority populations, the report concluded. Proper nutrition and physical activity are the cornerstones of treatment and prevention of type 2 diabetes, in addition to prescribed medications and regular medical screenings. But too many diabetics are failing to make necessary modifications in their diets or have not started exercise programs, contributing to complications in the management of their condition. High cholesterol, high blood pressure and detrimental lifestyle habits such as smoking or physical inactivity are still too common among diabetics, the report finds.
The report cited an analysis of national survey data for adults with diabetes, finding vast improvement overall in managing levels of blood sugar, blood pressure, and blood lipids that affect cholesterol. However, these are the troubling findings:
- 22 percent of adults with diabetes have A1C higher than 8 percent (a normal A1C blood test, which reflects average blood glucose levels over a period of 3 months, is below 5.7 percent) ;
- 28 percent have blood pressure higher than 140/90 (normal BP is 120/80 or below);
- 51 percent are on statins; 44 percent have LDL cholesterol levels higher than 100 mg/dL (LDL levels should be below 100 mg/dL, while levels of 100 to 129 mg/dL are of concern for diabetics or people with other heart disease risk factors);
- 20 percent use tobacco (smoking is a major risk factor for diabetes, other heart disease risk factors and many cancers)
For many people with type 2 diabetes and excess body weight, health care professionals should provide recommendations or referrals for diet, physical activity, and behavioral therapy designed to achieve at least a 5 percent weight loss, the report states.
An example of such follow-up care is a Baptist Health Primary Care program called Sweet Life Club [2]. Working with primary care physicians, or an endocrinologist, the Sweet Life team consists of a care coach, registered dietitian, certified diabetes educator, and a social worker — all overseen by a primary care doctor.
Sweet Life is designed to help manage or prevent diabetes, educate patients on nutrition and physical activity, improve body composition, reduce or eliminate medication dependency and effectively monitor blood sugar levels.
“Our participants receive classes related to diabetes and receive one-on-one attention,” says Cathy Clark-Reyes, registered dietitian with Baptist Health South Florida. “So wer’e not just saying that these are the things you should be eating. We’re sitting down with them and going over specific lifestyle changes to better manage their diabetes.”
Pascual De Santis, M.D. [3], an endocrinologist with Baptist Health Primary Care [4], says patients who work with this diabetes management professionals and take the time to make lifestyle modifications do very well in controlling blood sugar levels and preventing the disease from causing other health issues. In many cases, these patients don’t require medication after a certain period of time.
“There is good data to show that implementation of such (diabetes management) programs improve health outcomes and reduce costs,” says Dr. De Santis.