Diabetes - Ignorance is not bliss
“Screening, diagnosis and management all begins with primary care providers…,” said VA Puget Sound Health Care System Director of Diabetes Care Kristina Utzschneider.
Nov. 2, 2018 – As National Diabetes Month rounds to a close this November, it’s important to consider that, according to the Center for Disease Control and Prevention, more than 30 million adults in the U.S. have diabetes and 8.5 million of them do not know it. Nearly 77 million have prediabetes, a condition that can lead to diabetes, and do not know it.
Veterans, as a patient population overall, are especially vulnerable – twenty-four percent currently have a diagnosis of diabetes mellitus and more than 550,000 Veterans nationwide are at risk for amputation due to peripheral neuropathy and peripheral vascular disease.
Early detection and management is the best way to prevent the silent damage that leads to the problems inherent with the condition. Right now, before this month ends, may be the best time to schedule an annual clinical evaluation, assess the situation and develop a counteroffensive against a hidden enemy.
“Screening, diagnosis and management all begin with primary care providers,” said VA Puget Sound Health Care System, Director of Diabetes Care Kristina Utzschneider. “While VA-required screenings for complications from diabetes and associated education helps catch problems early (with the goal to prevent progression), treatment of diabetes is a team effort involving primary care providers, nursing, pharmacy, nutrition, podiatry and endocrinology specialists.”
A1c (measuring average blood sugar levels) is the most commonly used test to diagnose diabetes and, here at VA Puget Sound, the results are also used to help craft individualized treatment goals.
“We recently began recommending two newer classes of diabetes medications in patients with a history of cardiovascular disease if their A1c is not at target, as these newer medications have been shown in large clinical trials to decrease the risk of death and cardiovascular events,” said Utzschneider. “Prevention of cardiovascular disease is key as the risk is increased with diabetes and is the most common cause of death.”
“Helping patients to stop smoking, managing high blood pressure and treatment with statins to lower cholesterol are all key aspects of cardiovascular prevention,” said Utzschneider.
Keeping a vigilant watch on areas most likely to be simultaneously attacked is key to empowering patients and facilitating early and most effective intervention.
“Annual eye exams are recommended to detect and treat problems early to prevent blindness. We screen for early signs of diabetic kidney disease by checking the urine for protein and monitoring kidney function. Foot screenings are done annually - patients are educated on proper foot care and to see a health care provider early if there is a wound or ulcer on their foot.”
According to the CDC, having high blood glucose for many years can damage blood vessels that bring oxygen to some nerve endings. The most common type is peripheral neuropathy, which affects the arms and legs.
Nerve damage, along with poor circulation – another diabetes complication – can lower the ability to feel pain. Without pain, small cuts, blisters, sore or other problems can go undetected and become serious if left untreated.
“Good glucose and blood pressure control are important to help prevent or slow progression,” said Utzschneider. “Optimizing glucose control is important to prevent microvascular complications over time.”
As a flanking maneuver, VA Puget Sound offers classes to help patients understand diabetes better and to make important lifestyle changes to better manage this chronic condition. The MOVE program offers coaching, group support and the fun of like-minded camaraderie in taking charge of personal weight and learning to make healthy food choices that can have a large positive impact on diabetes management.
“For more complex patients, VA Puget Sound has an intensive insulin management clinic that is able to provide consultative assistance and access to state of the art devices for appropriate patients including insulin pumps and continuous glucose monitoring devices,” said Utzschneider. “The intensive insulin management clinic has also recently started offering telehealth visits to returning patients for whom travel to Seattle site is difficult.”
To launch all countermeasures, begin with being tested. To make an appointment with a VA Puget Sound primary care team call 206-762-1010 or 1-800-329-8387, ext. 71234.
To find out more about the VA Puget Sound MOVE! Program call 800-329-8387 and check out the national webpage at https://www.move.va.gov/.
To find out more about VA Puget Sound Patient Education go to https://www.pugetsound.va.gov/services/Healthy_Living_Classes.asp
To verify benefits and enroll in VA health care call 1-877-222-VETS (1-877-222-8387 Mon.- Fri., 8 a.m. to 8 p.m. (ET).
VA Puget Sound provides comprehensive care to more than 110,000 Veterans across its nine facilities in the Pacific Northwest. It has the 5th largest research program within the national VA system and seven Centers of Excellence (in areas from limb-loss prevention and prosthetic engineering to primary care education and substance abuse treatment). More than 2,000 individuals participate in its undergraduate and graduate training programs each year. For more information visit www.pugetsound.va.gov.
