Diabetic care '97

Drug Store News, Oct 20, 1997 by Faye Brookman

Sixteen million Americans have diabetes--and still only half of them are aware of the diagnoses, according to the American Diabetes Association. That's a number equivalent to the populations of the cities of New York, Los Angeles, Chicago and Dallas. These patients spend five times more on health care than healthy consumers do. They are important shoppers for drug stores because they need everything from foot care to sugar-free candies.

Diabetes is classified into two major types--Type 1 and Type 2 (previously called I and II). About 15 million suffer from Type 2. These people are generally those least likely to be aware of the problem.

Diabetes is about equally split between men and women with 49 percent of those with diabetes male and 51 percent female. Because Type 2 is often asymptomatic, people often have the condition for seven to 10 years before realizing it.

To help step up awareness of diabetes, the American Diabetes Association is augmenting the existing National Diabetes Month campaign with its own, called American Diabetes Month.

Since 1976, November has been named National Diabetes Month.

This, however, is the inaugural year for the American Diabetes campaign which has a goal to educate persons with diabetes about the importance of proper blood sugar control. While the other programs have been generated by companies who supply products, this is the association's effort to extend its message.

"Of those 16 million Americans who have diabetes, 24,000 will suffer from vision loss and, 54,000 will lose a foot or leg to amputations caused by diabetic nerve diseases this year. Others are at risk for heart, kidney or gum disease and stroke," stated material from the American Diabetes Association. "The good news is that these complications can be prevented or delayed through proper blood sugar control. The bad news is that most people with diabetes don't know how best to reduce their risk of these complications."

The theme of the American Diabetes campaign to help spread the word is "Diabetes: What to Know--Head to Toe." Chapters across the country will be hosting activities, such as health fairs, patient education seminars and eye and foot screenings. In fact, there will be more than 2,000 foot screenings nationwide.

Drug chains are linking up with local chapters of the American Diabetes Association. In San Jose, Calif., for instance, the local group will be hosting events in 35 Walgreens stores. The American Diabetes Association will also be making collateral materials available to supplement the program.

Paramount in the message is that there are three elements to maintaining proper blood sugar--controlling weight through meal planning and exercise, taking prescribed medications when required and monitoring blood sugar levels. Taking precautions, the association said, can eliminate amputations and other diabetes-related procedures.

Effective diabetes management, added the association, should be coordinated by a team of healthcare professionals, including physicians, nurses, registered dieticians, podiatrists and pharmacists. The pharmacist can help provide information that patients often can't readily access from physicians. "They can be the front line access," said the association spokesman.

The American Diabetes Association also urges patients to take the lead in their own care.

The American Diabetes Association has a web address with a variety of features including information and a bookstore for purchasing informative books on diabetes. People can also find out more by calling 1-800-DIABETES.

Because so many people are not aware of the chronic condition, new measures are being implemented to help identify people with diabetes.

The American Diabetes Association recently issued new guidelines at a meeting in Boston last June.

One recommendation that could have widespread impact is that screenings be carried out for people over 45. Studies show that by age 65, roughly 1-in-5 persons has the disease. "About 20 percent of people already have evidence of eye and kidney problems by the time they are diagnosed with diabetes and are two to four times more likely to have heart disease," said Richard Eastman, director of the division of diabetes, endocrinology and metabolic disease at the National Institute of Diabetes and Digestive Kidney Diseases. Extensive use of the FPG test could identify as many as 2 million of the 8 million undiagnosed Americans, he said.

Also, testing at a younger age was recommended for those more than 20 percent above ideal body weight, have a close relative with diabetes or are of a high-risk ethnic group. The panel dropped, however, previous recommendations that all pregnant women in their third trimester be screened--although gestational diabetes complicates 4 percent of pregnancies.

Other conclusions of the panel of experts formed two years ago included recommendations for:

* a fasting plasma glucose exam, a simple blood test conducted after the participant remains from eating for eight hours. This is the preferred course because it is simpler, less expensive and more acceptable to patients, making it more likely to be offered regularly;