Aside from reading scholarly papers in journals, it is imperative to attend continuing medical education conferences to keep up-to-date with the prevailing theories and practical application of diabetes management (as well as to maintain professional licensure). The ADA post-graduate course is just one of many professional gatherings for physicians, nurses, dieticians, psychologists, social workers, exercise physiologists, pharmacists and any other specialty that treats people with diabetes. This conference provides late-breaking information and consensus guidelines for all professionals. The 2011 course had several concurrent sessions and workshops to allow for different healthcare specialists interests and needs. Much of the plenary sessions discussed the rising cost of diabetes health care and the need for strategies to prevent diabetes, which of course, are NOT financially cost-effective. I would like to discuss four prevailing themes of the 3-day session that resonated with me and two of my diabetes nurse educators that attended the conference. (My only disappointment was that most of the sessions were focused towards type 2 diabetes in view of the fact that 90 percent of all people with diabetes have type two.)
- 1. The key to decreasing diabetes healthcare costs is to prevent diabetes in the first place. Pre-diabetes (fasting blood sugar between 100 mg/dl-125 mg/dl) can be diagnosed and treated with both lifestyle changes and medication to prevent or delay type 2 diabetes. There are several large evidenced based studies (one in the New England Journal of Medicine) that have demonstrated these results. Lifestyle change refers to the following measures. If obese, the loss of approximately 7 percent of body weight, along with 30 minutes of daily exercise will increase endogenous insulin sensitivity (and thereby decrease insulin resistance) and help to prevent or delay the onset of type 2 diabetes. Metformin (Glucophageâ), an insulin-sensitizer, also played a role in decreasing insulin resistance (more on this pharmaceutical agent later). So, with these facts, why is not everyone adapting these life style changes if they are at risk?
The answer: Behavior change is hard. This speaks to me, of course. And for the next two days after the conference, I got on my treadmill. Let's see if it continues. In regard to metformin administration, please talk to your healthcare team. It might help. Lastly, there was information in regard to bariatric surgery and guidelines. Apparently, they have eased some of the restrictions and more people with less severe obesity may be eligible for bariatric surgery. Bariatric surgery can improve glycemic status in obese people with diabetes extremely quickly and increase insulin sensitivity dramatically. The important thing to remember, however, is that there can be significant side effects depending on the different procedures. It is essential you talk to your healthcare provider to get the facts.
On the last day of the conference, one of the speakers discussed a program for populations with pre-diabetes that addressed behavior changes including diet and exercise that were supervised by people from the community at YMCA's in various cities. He provided some positive data in regard to these interventions. Of course, these leaders were trained by the appropriate healthcare professionals in the community, and people were to be cared for and given appropriate medical advice by their healthcare team. There were major concerns, however, in regard to coverage by insurance companies, sparking major debate in the audience.
2. Behavior change. So, if we have admitted that behavior change is difficult (if not impossible), how are we going to get people to do what they might not like to inherently do? Several presentations discussed strategies to lose weight, change the way we think and tips to cut calories. One presenter discussed "mindless eating" and provided an interesting strategy: make one positive eating change and see what follows. Indeed, he demonstrated very positive results after different individuals adopted these changes. Another speaker discussed the important intervention of denoting calories on all food choices in restaurants. This was an incredibly effective deterrent as we went to Starbucks for a coffee break. Those lemon pound cake slices have gobs of calories. Needless to say, I just had coffee with artificial sweetener (but with half and half)! At dinner, we actually paid attention to the calories listed on the menu and tried to make informed reasonable choices. The restaurant manager also told us that all New York restaurants were required to list calories if prices were on the menu. However, if prices were not listed, they were not required to list the calories. I guess if people have unlimited financial resources, they can have unlimited caloric resources as well! So, one change for us (at least in New York) was to pay attention to those calorie listings! As of this writing, I have adhered to my treadmill routine 75 percent of the time. Not perfect, but who really is?
Next week: Part 2: Take-Home Lessons from NY ADA Post-graduate Course: Medication Safety and The Artificial Pancreas
Published On: March 08, 2011