|
The
ABC's of Diabetes Care
October/November 2002 As the prevalence of diabetes escalates at an alarming rate, key leaders in the prevention and treatment of diabetes have developed a new campaign for diabetes education and management. The ABC's of diabetes care refer to a patient’s Hemoglobin A1c, Blood pressure, and Cholesterol. Diabetes management is focusing on maintaining a Hemoglobin A1c within normal limits or less than 7% (American Diabetes Association, 2002b.) Blood pressure needs to be controlled and less than130/80 mm Hg (American Diabetes Association, 2002d.) Cholesterol levels for LDL need to be less than 100 mg/dl, HDL needs to be greater than 45 mg/dl, and triglycerides need to be less than150 mg/dl (American Diabetes Association, 2002c.) People with diabetes need to know their ABC numbers. Health care providers need to help diabetic patients maintain their ABC numbers. Adherence to the A,B,C’s of diabetes care may help reduce the adverse outcomes of diabetes, like blindness, kidney disease, limb amputation, heart attack and stroke. There are two types of diabetes. Type 1 occurs primarily in children and is often the result of an autoimmune snafu. The body begins to attack the beta cells of the pancreas. As a result, the pancreas of type 1 diabetes patients no longer produces insulin. Type 1 diabetes represents 5-10% of all cases of diabetes, while type 2 diabetes represents 90-95% of all diabetes cases. Type 2 diabetes results in the decreased insulin sensitivity of cells in the body and the subsequent inability of the cells to respond to insulin properly. Type 2 diabetes is most common in adults over the age of 40 years but the prevalence is increasing among younger adults and adolescents. The prevalence of diabetes increased by 33% from 1990 to 1998 and occurred in both genders and all races, ages, levels of education and geographic areas in the United States (Center for Disease Control [CDC], 2001.) Additionally, the prevalence of diabetes was very closely correlated with the prevalence of obesity (Mokdad, AH, et. al, 2000). Prevention of diabetes has focused on type 2 diabetes because the risk factors associated with type 2 diabetes, obesity and poor nutrition are modifiable. Obesity does not predict the development of type 2 diabetes. However, physical inactivity and poor nutrition can increase a person’s risk of developing insulin resistance, which is a precursor to diabetes (Partnership for Prevention, 2002). Adult and pediatric obesity in the United States has become a national epidemic. It is estimated that over 60% of Americans are overweight (Mokdad, et al., 2000). Obesity in adults is considered a BMI (body mass index) greater than 30. Adults are considered overweight if their BMI is 25 or greater. The prevalence of overweight children has increased in the last two decades by 50% (Nichols & Livingston, 2002). The prevalence of type 2 diabetes in children is also increasing. Identifying overweight and obese children is not straightforward. Due to the fluctuation of a child’s BMI throughout the growth process, it is difficult to establish a standard definition for overweight and obese children (Nichols and Livingston, 2002). The current national guidelines state that a child is considered overweight if s/he is at or above the 80th percentile of weight for height on the standardized growth charts and obese if s/he is over the 85th percentile. Up to 80% of children diagnosed with type 2 diabetes are overweight (American Diabetes Association, 2002a). Developing diabetes at a young age increases the chance for diabetic vascular and neurological co-morbid conditions to occur. Encouraging regular physical activity and promoting healthy nutritional habits at home, work, and school are the cornerstones to preventing diabetes and diabetes-related diseases. Consistent, quality diabetes screening and management may help our country stop the progression of this chronic disease. But for the time being, patients and health care providers need to be proactive about knowing and managing the A,B,C’s of diabetes care. The American Diabetes Association, the Centers for Disease Control and the Partnership for Prevention are excellent resources for current issues and prevention strategies for the management of diabetes. References: American Diabetes Association. (March, 2002a). Diabetes in Children. Retrieved from http://www.diabetes.org/main/application/commercewf?origin=*.jsp&event=link(B4_3). American Diabetes Association. (2002b). Management of Dyslipidemia in Adults with Diabetes. Diabetes Care, 25, 74-77. American Diabetes Association. (2002c). Tests of Glycemia in Diabetes. Diabetes Care, 25,S97-S99. American Diabetes Association. (2002d). Treatment of Hypertension in Adults with Diabetes. Diabetes Care, 25, 71S-73S. Centers for Disease Control. (2001). Press Release: Twin Epidemics of Diabetes and Obesity Continue to Threaten the Health of Americans. Atlanta, GA: Author. Retrieved March 17, 2002 from http://www.cdc.gov/od/oc/media/pressrel/r010911.htm. Mokdad, AH, Ford, ES, Bowman, BA, Nelson DE, Engelgau, MM, Vinicor, F., & Marks, JS. (2000). Diabetes trends in the U.S.: 1990-1998. Diabetes Care, 23 (9), 1278-83. Nichols, MR & Livingston, D. (2002). Preventing pediatric obesity: Assessment and management in the primary care setting. Journal of the American Academy of Nurse Practitioners, 14 (2), 55-62. Partnership for Prevention. (March, 2002). Diabetes: Common, serious, costly, getting worse and preventable. Priorities in Prevention. Retrieved from http://www.prevent.org/Winword/diabetes.pdf.  Stefanie J. Kelley, ND, RN, CS has been in the nursing field for over 10 years. She has clinical expertise in general pediatrics and pediatric hematology, oncology, and bone marrow transplantation. As a family nurse practitioner she has advanced practice expertise in internal medicine, urban health care, and general pediatrics. As a faculty member at Texas A&M University and Case Western Reserve University, she has taught in the undergraduate and graduate didactic and clinical portions of nursing. Dr. Kelley's interest in web-based instruction and health care has been a part of her academic, clinical, and research practice.
|
|
Site Design and Development by AccuVis |
 |
