Well-rounded care benefits diabetics

WASHINGTON, Jul 18, 2005 (United Press International via COMTEX) -- Leading an organized, healthy lifestyle and focusing on nutrition and exercise along with proper medical care can help diabetics keep their blood sugar at a proper level and slow possible negative complications of the chronic disease, researchers have found.

"It isn't just sugar," that affects a diabetic, said Dr. Harvey Katzeff, chief of the endocrinology division at North Shore Long Island Medical Center in New York. "Every time a diabetic individual eats a meal, they have to consider what will happen to their blood sugar, what it will do to their weight, and what it will do to their health."

Katzeff and others spoke at a news conference recently sponsored by Becton, Dickinson and Company, a medical-technology firm in Franklin Lakes, N.J.

Robert Singley, vice president of worldwide insulin delivery at BD Medical Diabetes care, said a comprehensive approach is needed to manage the disease, which currently affects more than 18 million Americans.

Last fall, the company organized a team -- consisting of an endocrinologist, diabetes nurse educator, registered dietician, exercise physiologist and professional organizer -- to help five patients learn to manage their diabetes.

"Every participant lowered their blood glucose level into the target range," Singley said of the patients who participated in the eight-week program, called the National BD Diabetes Makeover.

Team members created individualized diet and exercise plans for each patient, provided them with information about their disease, and contacted them weekly to evaluate their progress and provide support.

Now, the team is focusing its efforts on three Washington, D.C., patients, who have been participating for the past month in the second phase of the program.

"All of our patients are clearly doing better than they were when they started the program," Katzeff said. "Hopefully, they will be able to maintain this improved blood sugar control for the long term -- and that's really our goal."

Diabetes is a chronic disease that results from a defect in the body's ability to produce or use insulin, which regulates glucose levels in the blood. There are two main types of diabetes. Type I usually is diagnosed before age 30, and is regulated through diet, exercise and daily insulin shots. Type II can develop at any age, but the risk increases with age. It is associated with obesity, physical inactivity, nutrition and family history, and is commonly treated with oral medication.

Between 90 percent and 95 percent of the U.S. diabetic population has type II diabetes, according to data compiled by BD.

Addressing caloric intake and exercise is particularly important for overweight Type II diabetics, because it could keep them from having to escalate their medical care to include insulin injections, Dr. Martin Abrahamson, acting chief medical officer at the Joslin Diabetes Center in Boston, told United Press International.

"If you have people who don't really pay attention to their meal plan, and don't understand the relationship between insulin, food and exercise, their glucose control is going to be haphazard," Abrahamson said. "Not addressing the multi-faceted components of diabetes care is only detrimental to the patient in the long-run."

Participants in both the nationwide and Washington programs were chosen because they demonstrated a lack of control over their disease, said Rita Saltiel-Berzin, manager of diabetes education at BD.

In the Washington program, Sandra Panchak, 61, was diagnosed with Type I diabetes at age 30 and was referred to the program through her physician.

"This is kind of a re-commitment in awareness of what I need to do to better control (the disease)," Panchak told UPI. "I always (monitored) my blood sugar, but I wasn't really keeping track of the food part, and now I can see what I eat, how much insulin I give myself, and what the results are, so it will help in planning."

The team recommends a diet rich in fruit, vegetables and high-fiber foods such as brown rice, whole-wheat pasta and legumes. Regular exercise also is important because it can lower blood glucose levels and cholesterol, according to the diabetes program manual.

"If you can control, not just the diabetes, but also high blood pressure, high cholesterol, stop smoking, and do all of these things to change your lifestyle, then people with diabetes can achieve in many ways a normal life and a normal life expectancy," Katzeff said.

Last year, about 320,000 people died of diabetes-related complications in the United States, and about $132 billion was spent on diabetes-related expenses in 2002, Rep. Jim Ramstad, R-Minn., member of the House Health subcommittee, said at the news conference.

The risk of diabetes-related complications -- including kidney failure, heart attack, stroke, blindness and lower extremity amputations -- can be reduced when the disease is properly managed, Abrahamson said.

"The big challenge is to ensure that patients have access to the facilities that can provide these services," he said.

Diabetics who are age 65 or older and enrolled in Medicare are provided with resources for management, and can receive nutrition-therapy counseling, self-management training, glaucoma testing and eye and foot exams, according to the U.S. Department of Health and Human Services manual, "Medicare Coverage of Diabetes Supplies & Services." The program covers supplies, including diabetes blood-sugar testing equipment, insulin pumps and therapeutic shoes, for Medicare recipients with certain medical conditions.

Resources for diabetes management are available, but "people who have diabetes have to find these programs, and that is pretty much hit or miss," Saltiel-Berzin told UPI.

The American Diabetes Association's Web site provides information on education courses available in different areas, she said. The Web site also provides information on healthcare options for many other diabetics, including those with employer-provided healthcare, low incomes, children with diabetes and military veterans.

Joslin clinics, located throughout the country, offer another resource for diabetics looking for comprehensive care, Abrahamson said. The centers focus on patient care, education and diabetes research.

Patient results of the current diabetes makeover program will be announced Aug. 13 at the American Association of Diabetes Educators meeting in Washington.

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Catherine Sharoky is an intern for UPI Science News. E-mail: sciencemail@upi.com