Health programs try to slow progression of diabetes

Published online on Sunday, Feb. 15, 2009

At the Visalia Oak Health Center, doctors know all about diabetic patients even before examining them.

A computer tracking system alerts doctors to a patient's health needs. They know if the patient is due for a foot exam to check for nerve damage, an eye test to look at blood vessels or laboratory work to measure blood-glucose levels.

It doesn't matter if the patient is there for something else — a cough, cold or backache. The diabetes registry tells the doctor what diabetes care the patient needs.

"The goal is to prevent the progression of diabetes complications," said Erik Persell, a physician's assistant.

This is the type of program that could help bring the diabetes epidemic under control, health experts say. But the high cost of expanding programs has been a barrier. The very scope of the problem is daunting.

Diabetes is a societal disease. The fight can't be confined to treating one patient at a time. It's a battle against obesity, poverty, a doctor shortage, urban sprawl — factors found in abundance in the Valley.

"We've got to make people realize this is not simply just poor eating behaviors, poor lifestyle choices," said Rudy Ortiz, a UC Merced professor who studies obesity and diabetes. "There are issues in the workplace, in the community, in the schools that all contribute to this."

And everyone agrees more needs to be done. If things don't change, one-third of the children born in 2000 will develop the disease sometime in their lives. That puts thousands of 9-year-olds needlessly at risk of heart attack, stroke, blindness and amputations later in life.

Sounds hopeless. But each small step helps. In the waiting room

At least 25% of the patients seen at the Visalia clinic are diabetic. And half of patient visits are related to diabetes, said Dr. Christopher Rodarte, the medical director.

Diabetes requires doctors, physician assistants, diabetes educators, nutritionists, psychologists — and the patient — working together to keep a patient’s blood-sugar levels under control, he said.

Family HealthCare Network, which runs the Visalia clinic, spent nearly $50,000 on the computerized diabetes registry. The system replaces a manual registry that was time-consuming and often out of date.

The registry has had concrete success:
* A comparison of diabetes patients before and after the computer tracking found that 61%, up from 25%, had received a pneumonia vaccine. This is important because diabetes patients are more at risk of pneumonia.
* Sampling suggests that nearly half of patients, up from 20%, received a retinal screening to detect eye problems. Diabetes is the leading cause of new cases of blindness among adults in the United States.

Not enough money

So far most diabetes-prevention programs have been accomplished on a shoestring budget, advocates say. That’s despite evidence that prevention programs save money.

Foot-care programs to prevent amputations reduce a diabetic’s health-care costs by about $900 over five years, according to a federal report in 2000. Blood-pressure screenings to decrease the risk of heart attack and stroke save $900 over a diabetic’s life.

Overall, every $1 spent training people to take care of their diabetes saves up to $8.76 in health-care costs, the report concluded.

But funding for diabetes prevention in California has been lacking for some time, said Lisa Murdoch of the American Diabetes Association.

The California Diabetes Program is charged with reducing the prevalence of the disease. Its $1 million annual budget is entirely funded by the federal Centers for Disease Control and Prevention.