Amid the high-profile efforts to find better ways to combat killers such as lung cancer or short- circuit bird flu or fashion an AIDS vaccine, a less glamorous problem is quietly attracting attention.


Doctors, insurers, employers and even elected officials are considering how to improve diabetes care.

Physicians know plenty about what works. Nearly a dozen simple tests are proven to help diabetics live longer and avoid the kidney failure, blindness, limb loss and other problems that often stalk them.


Worried about amputation?
The American Diabetes Association reports that proper foot care, including an annual professional examination, cuts the risk as much as 85 percent. Worried about diabetes-related vision loss? The association notes the right screening and follow-up care cut the risk of severe vision loss up to 60 percent.


The real challenge is making sure patients like Charlie Cahill of Frayser, or Carolyn Cox of southeast Memphis, get those and other checks, along with help controlling their blood sugar.


Cahill has battled diabetes since 1961. Now 76, he's had some of the vision changes and heart disease common among diabetics.

Follow up:

Cox, 43, was diagnosed about 10 years ago. So far, she's escaped the amputations, heart disease and kidney failure that led to her sister's early death and left her mother and grandmother disabled. But controlling her blood sugar is a struggle.

"She is typical in that she has a lot of things going on. It is not just elevated sugars in isolation. Patients have other issues besides diabetes -- transportation issues, socioeconomic issues, problems getting medicine,"

said Dr. Beverly Williams-Cleaves, a University of Tennessee Health Science Center associate professor and Cox's diabetes specialist.


Insulin and other medications help keep diabetics alive by making sure they can turn food into fuel for cells. Preventing long-term complications is trickier. It requires balancing food, exercise and insulin to protect organs and blood vessels by preventing the high blood sugar levels.


The 2005 Memphis Behavioral Risk Factor


Survey found that while a growing percentage of the Shelby County residents with diabetes surveyed reported receiving some recommended screenings, well under 50 percent received all.


That translates into unnecessary death and suffering.

"If people with diabetes get all the recommended care they need, they are much less likely to die prematurely or suffer serious disability like amputation and blindness,"

said Dr. James Bailey, University of Tennessee Health Science Center's chief of general internal medicine.


The phone survey was conducted by the University of Memphis Mid-South Social Survey Program. It was funded by the Urban Child Institute and involved 1,887 Shelby County adults. About 11 percent were diabetic. It is part of a collaboration involving UofM, UT Health Science Center and the Healthy Memphis Common Table.


It is easy to find someone to blame.


There are the patients who avoid doctors, sometimes because they can't afford care, or skip education sessions.
There are the physicians who schedule so many patients there's only time to discuss urgent problems.

There are the insurance companies that pay doctors for quantity, rather than quality.


But driven partly by increases in health spending and rising diabetes rates, attitudes are changing.
Some projects are simple. Methdodist Healthcare Foundation received a grant earlier this year to develop easy-to-read information about diabetic foot care and injury prevention.


New electronic medical records typically include automatic reminders to order recommended screenings. Some programs won't let doctors close a file until missing tests are scheduled.


Other projects tackle broader questions about the nation's system of delivering and paying for care.


Medicare, the federal health program for older and disabled Americans, is funding disease-management pilot programs in Tennessee and six other states. They want to know if providing extra support, education and followup for patients with diabetes and heart failure will save Medicare money in the long run by keeping patients healthier. After three years, they'll compare the results of patients who receive those services with those who don't.


In Tennessee, XLHealth was hired to run the program for 20,000 Medicare patients, including about 4,200 in Shelby County.


They receive free transportation to the company's office in a southwest Memphis office park, where they get recommended tests, equipment and support. The staff follows up with the patient's doctor.


Cahill, a retired music teacher, credited XLHealth with prompting him to check his feet regularly. They arranged for him to receive shoes that provide additional support and protection.


"I don't want to lose my feet," he explained. Diabetic nerve damage means patients might not realize they've injured their feet.


The Memphis Business Group on Health is involved in at least three projects designed to bring employers, physicians and insurers together to reconsider diabetes management.


In one project, local businesses are using the "diabetes calculator" federal officials developed to help employers estimate how the disease is affecting their bottom line.


Another encourages physicians to gauge how they compare with their peers when it comes to diabetes care.



The Memphis business group is also crafting a pilot project that looks at whether it can improve diabetes care by revamping insurance reimbursement.

"It would need to be a long-term project. It isn't necessarily a quick return,"

said Cristie Travis, the group's chief executive officer.


Travis is also directing a project for the Healthy Memphis Common Table focused on improving care of individuals with diabetes, asthma, heart failure and other chronic diseases. The Healthy Memphis Common Table is a private, nonprofit organization launched in 2003 with dozens of public and private partners. It hopes to reduce local rates of diabetes and obesity.


This project, which will involve physicians and consumers, is being funded with a $600,000 grant from the Robert Wood Johnson Foundation. The money will support a three-year effort to track how well individual physicians follow treatment guidelines. The idea is to get more doctors providing recommended care and get more consumers asking for it, Travis said.


The Church Health Center and Harbor of Health are among the local providers trying new ways to handle routine diabetes care. Along with regular doctor visits, they are trying group appointments and tapping nutritionists and others to do more patient education and counseling.


Dr. Scott Morris, health center executive director, said the group appointments average two hours and provide an efficient way to do routine screening and patient education.

"It becomes very much a group support and cheerleading experience,"

he said.


The center, which cares for working, uninsured adults, also requires all newly diagnosed diabetics to complete four patient education classes.

"If you don't go to class, you can't come back here. Period. It (diabetes management) has to be a team approach. Having the doctor know all about your diabetes is not that helpful,"

Morris said.


In Memphis, efforts also continue to open a diabetes center at The Regional Medical Center at Memphis. The goal is to make it easier for patients to get recommended screenings and counseling by offering them all in a single location. It is similar to the diabetes malls Gov. Phil Bredesen proposed earlier this year. That plan called for spending roughly $15 million on malls in Memphis and in rural Middle Tennessee. It failed to attract legislative support.


Cox likes the idea.

"It would be great to have a single place for diabetics to go,"

she said. Cox said what she needs most is help losing weight. Being overweight increases a person's risk of diabetes.


Meanwhile, there are also simple measures physicians and patients can take to improve care.


Williams-Cleaves said simply having patients remove their shoes and socks before the doctor walks into the exam room makes a foot exam more likely.

"The average internal medicine patient has five problems. It is not easy to deal with all of those problems in the time allotted" for most doctor visits, she said. "I allow 30 minutes and that is not enough time."

Bailey recommends anyone with diabetes make a checklist to keep up with recommended screenings.


Thanks to his daughter, Cahill has the Cadillac of checklists.


She developed a loose-leaf, three-ring binder with sheets Cahill uses to make a daily record of what he eats, his blood sugars, blood pressure and activity. It's also where he keeps disease information and medications.


Cahill said making a record keeps him motivated.

"I'm more conscious of it and my own health. I'm not taking it for granted,"

he said.


Source: Health & Fitness


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