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Diabetes: The Tsunami of Diseases

Experts from Montefiore Medical Center Available for Interviews

November 2011 is Diabetes Awareness Month

More than Half of All Americans Will Have Diabetes by 2020 - Ranks Could Swell to 135 Million

Half of all American adults are destined to develop diabetes or pre-diabetes by 2020 if they don't make dramatic lifestyle changes, according to a dire new prediction from the Centers for Disease Control and Prevention. If current trends continue, the ranks of American adults with excessive blood sugar levels would swell from 93.8 million this year (about 28 million diabetics and 66 million more with pre-diabetes) to 135 million in 2020 - and cost society $3.35 billion by decade's end. In addition, diabetes is becoming one of the most common chronic diseases in children and adolescents. According to the American Diabetes Association, one in every four children is currently diagnosed with diabetes. Dr. Joel Zonszein believes that unless healthy lifestyle changes are made early in life, diabetes could become an epidemic of tsunami-like proportions. Montefiore has been collaborating with the Diabetes Research Center and Training Center (DRTC), focusing on diabetes education, professional training and community outreach.

Joel Zonszein, MD, CDE, FACE, FACP, Director, Clinical Diabetes Center, Weiler, Professor of Clinical Medicine, Albert Einstein College of Medicine

American Diabetes Association Recommends Popular Diabetes Drug Metformin to Treat Pre-diabetes

Pre-diabetes, which affects an estimated 79 million Americans, has been termed "America's Largest Healthcare Epidemic." The Diabetes Prevention Program (DPP), a study published in The New England Journal of Medicine by scientists at Montefiore and Albert Einstein College of Medicine, found that diabetes can be prevented. In the DPP study, the incidence of diabetes in this high risk group is 11 percent when nothing is done. However, with lifestyle changes, it can be reduced to 4.8 percent and when metformin is used, it is reduced to 7.8 percent. Therefore, metformin, a drug typically used to treat diabetes, is advocated, combined with lifestyle changes, to effectively prevent or delay the onset of diabetes. The condition is diagnosed when blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. Recent research has shown that long-term damage to the body, affecting the heart, nerves, kidneys and eyes, may already be occurring during pre-diabetes.

Joel Zonszein, MD, CDE, FACE, FACP, Director, Clinical Diabetes Center, Weiler, Professor of Clinical Medicine, Albert Einstein College of Medicine

Disease Management Program Improves Outcomes

The Bronx has one of the largest, highest-risk and most difficult-to-treat populations of diabetes patients in the city and the nation. Through a care-management program called the CMO, or Care Management Organization, Montefiore Medical Center has found a way to improve outcomes in Type 2 diabetes patients in a low income, urban setting. In fact, A1c glucose levels in 1,000 patients have been successfully reduced by 16 percent from 2008 to 2009, while at the same time reducing healthcare costs and decreasing hospital re-admissions by 16 percent. Six certified Diabetes educators (CDEs) actively manage patients through telemedicine and electronic medical records, as well as on-going education and support by a team of professionals that augment a patient's relationship with their physician. A patient's blood sugar levels are sent each day to a care management nurse - if their A1c levels get too high, the patient receives a phone call to determine the need for a medical intervention.

- Jon Swartz, MD, MBA, FAAFP, Internist, Care Management Organization (CMO)
- Sandra Barnaby, RN, MPH, Chronic Disease Mgr.

Education is Key in Fighting Diabetes

With the guidance of Nurse Practitioner Sheila Felleman, free interactive diabetes workshops meet monthly throughout the Bronx and lower Westchester to help educate patients how to manage living with diabetes. These classes are led by RNs and LPNs who are Certified Diabetes Educators and are offered in both English and Spanish. They discuss, in a culturally sensitive way, proper foods, myths and facts and maintaining glucose levels. They look at an actual map of a sample neighborhood and "visit" food markets, discuss the right foods to buy and then go over specific recipes that are popular with a variety of populations. These groups, provided by the Care Management Company (CMO) of Montefiore, are open to everyone.

Sheila Felleman, RN, MPA, Director of Chronic Care Montefiore Medical Center Care Management Organization (CMO)

Simple Blood Test to Determine Blood Sugar Level

Hemoglobin A1c provides an average of the blood sugar control over a six to eight week period and is used in conjunction with home blood sugar monitoring to make adjustments in diabetes medicine dosages. Levels higher than 7 percent may result in the development of complications from the disease. Recently, this test was approved for diagnosis as well - levels of 6.5 percent or higher pinpoints the disease. Montefiore Medical Center now offers it to all employees who are at high risk for the disease. Risk factors include obesity, high blood pressure and abnormal cholesterol.

Rita Louard, MD, Director, Clinical Diabetes Center, Moses, Associate Professor of Clinical Medicine, Albert Einstein College of Medicine

Diabetes Emerges as a Growing Health Issue for Both Mothers and Babies

Approximately 3-5 percent of pregnant women suffer from gestational diabetes, which is defined as diabetes during pregnancy. Many women don't even know they have type 2 diabetes until they begin seeing their doctor during pregnancy. A recent international study, Hypoglycemia and Adverse Pregnancy Outcome (HAPO), indicated that higher maternal glucose levels are associated with higher rates of adverse obstetrical outcomes, which include risk of miscarriage, urinary tract infections, dental disease and poor wound healing. Pre-diabetes also can have profound long term effects on the newborn baby, by altering metabolism and increasing its risk for developing diabetes and heart disease. However, there is hope -- pregnant women are a relatively captive audience and are often more open to education. It also gives health care professionals an opportunity to counsel the entire family since diabetes management and treatment is relatively similar for all adults. Montefiore has been offering tailored diabetes education emphasizing lifestyle changes focusing on physical activity, food choices and portion control. As needed, additional medical interventions to lower glucose values are also prescribed. Dr. Henderson is part of a gestational diabetes initiative by the New York State Department of Health, which was awarded to Montefiore as a Diabetes Center of Excellence, to identify and diagnose risk factors for the disease.

Cassandra Henderson, MD, CDE, Ob/Gyn and Certified Diabetic Educator, Department of Obstetrics & Gynecology and Women's Health, Division of Maternal-Fetal Medicine, Associate Professor, Albert Einstein College of Medicine

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