Diabetes case management that takes a patient’s specific culture into consideration can help increase life expectancy and decrease the incidence of diabetes-related complications over the patient’s lifetime, a new study finds.
“Better management results in reduced long-term complications, such as blindness, stroke, amputation and nerve damage,” said lead researcher Todd Gilmer, Ph.D.
The research focused on 3,893 people with diabetes who participated in San Diego’s Project Dulce, which set out to meet American Diabetes Association standards of care. The target population was primarily low-income, underinsured Latino people.
Study participants showed “clinically significant improvements in A1c, blood pressure, low-density lipoprotein and triglycerides,” said Gilmer, an associate professor in the department of family and preventive medicine at the University of California, San Diego.
Hemoglobin A1c — a measure of how well patients control their blood glucose — low-density lipoprotein (“bad cholesterol”) and blood pressure are commonly managed risk factors among diabetes patients.
The study appears in the latest online issue of Health Services Research.
The clinical team included a registered nurse/certified diabetes educator and a medical assistant and a registered dietitian who were bilingual and bicultural. Patients underwent an initial 50-minute visit with a nurse and were asked to return for additional visits. They also had a 25-minute visit with the dietitian and were called by team members for appointment reminders.
Patients also participated in a group self-management training program consisting of an eight-week curriculum delivered by trained peer educators who had diabetes themselves and were of the same cultural or ethnic group as the participants.
The researchers used the resulting clinical and cost data in what Gilbert describes as “a model that simulates long-term effects of implementing health policies for the management of diabetes.” The model estimates the number of years of life patients gain from treatment — adjusted for quality of life — for the amount spent to deliver the treatment.
Direct medical costs over a patient’s lifetime were higher for patients who received case-management and self-management training help. Nevertheless, a further breakdown showed that about one-third of the additional costs of implementing the intervention were offset by reduced expenses of diabetes-related complications over patients’ lifetimes.
“If these individuals live longer without these complications … it gives them a higher quality of life,” Gilmer said. “It is worth it.”
“Strategies such as [those used in the study] should help our awareness of the needs to reach overall goals and prevent long-term complications related to diabetes,” said Julienne Kirk, Pharm.D., an associate professor in the department of family and community medicine at Wake Forest University.
The results of the study should encourage health systems to consider setting up similar case-management and self-management training programs for their high-risk populations, Gilmer said.
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Health Behavior News Service: Lisa Esposito at (202) 387-2829 or hbns-editor@cfah.org.
Health Services Research is the official journal of AcademyHealth and is published by Blackwell Publishing on behalf of the Health Research and Educational Trust. Contact Jennifer Shaw, HSR Business Manager, at (312) 422-2646 or jshaw@aha.org. HSR is available online at www.blackwell-synergy.com/loi/hesr.
Gilmer TP, et al. Cost-effectiveness of diabetes case management for low-income populations. Health Services Research online, 2007.
FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or www.hbns.org. Center for the Advancement of Health
Health Behavior News Service
Contact: Lisa Esposito, Editor
202.387.2829
hbns-editor@cfah.org
In a Message to Canadians, Health Canada, the Competition Bureau, the Public Health Agency of Canada and the Canadian Diabetes Association warns Canadians about the scams floating around regarding so called miracle cures for diabetes.
No. Today, diabetes can be managed, but there is no cure for diabetes yet. Any product that claims to be a miracle cure for diabetes is a fraud that could cheat you of time, money and most importantly, your health.
There are many scams designed to prey on consumers with diabetes who are hoping to find solutions to living with this chronic disease.
Until researchers find a cure, the only safe way to manage diabetes is to follow the treatment program designed by your health care practitioner.
Approximately two million Canadians have diabetes. Diabetes occurs when the body can’t produce or properly use insulin. Insulin is a hormone that ensures your body gets the energy it needs to work. Over time, diabetes can lead to complications such as blindness, heart disease, kidney failure, limb amputations, nerve damage and erectile dysfunction. The risk of longterm complications can be reduced through effective health care, education and selfmanagement.
There are three types of diabetes. Type 1 diabetes, usually diagnosed in chi?dren and adolescents, occurs when the body makes little or no insulin. Type 2 diabetes, the most common form, occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin produced. Type 2 diabetes usually develops in adulthood, although increasing numbers of children in highrisk populations (i.e. Aboriginal, Asian, Hispanic and African) are being diagnosed.
The third type of diabetes, known as gestational diabetes, is a temporary condition that develops during pregnancy but disappears after the baby is born. Both mother and child have an increased risk of developing type 2 diabetes later in life.
Lifestyle changes can help prevent or delay the onset of type 2 diabetes. Healthy eating, weight control and physical activity are important prevention steps. Type 1 diabetes is always treated with insulin.
Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to help your body make or use insulin more effectively.
Be skeptical: if it looks too good to be true, it probably is! There is no pill, herb or “all natural” health product that will miraculously cure diabetes.
Here are some tips on spotting scams:
Consult your health care practitioner before trying any new treatment. A doctor, nurse, or health care professional who knows your medical condition is your best source of information.
Consumers should be aware that, before a health product can be advertised or sold in Canada, the manufacturer must first provide Health Canada with evidence that the product is safe and of high quality. The product must also perform as claimed. Drugs and natural health products that are authorized for sale in Canada will have either an eightdigit Drug Identification Number (DIN), a Natural Product Number (NPN) or a Homeopathic Medicine Number (DINHM) on the label. These numbers indicate that the products have been assessed by Health Canada for safety, effectiveness and quality.
Under the Food and Drugs Act, no person is permitted to package, treat, process, sell or advertise any drug in a manner that is false, misleading or deceptive or is likely to create an erroneous impression regarding its character, value, quantity, composition, merit or safety.
The Competition Bureau is responsible for the administration and enforcement of the Competition Act as well as three labelling statutes that ensure Canadians are provided with acc?rate and meaningful information to make informed purchasing decisions. Under the Competition Act, all advertisers must ensure that their claims are true and accurate prior to putting their products on the market. In particular, performance claims made for the promotion of a product must be true and must be based on adequate and proper tests, such as those undertaken by an accredited scientific facility or recognized expert.
The mission of the Public Health Agency of Canada is to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. The Agency focusses on effective efforts to prevent chronic diseases, like diabetes, cancer and heart disease, to prevent injuries and to respond to public health emergencies and infectious disease outbreaks. The Public Health Agency of Canada works closely with the provinces and territories to keep Canadians healthy and help reduce pressures on the health care system.
If you have questions or would like file a complaint relating to a diabetes product or scam, contact:
Information Centre Competition Bureau
50 Victoria Street
Gatineau QC K1A 0C9
Toll-free: 1-800-348-5358
National Capital Region: 819-997-4282
TDD (for hearing impaired):
1-800-642-3844