Glycemic control Self blood glucose monitoring Self care education Medical nutrition therapy Glycemic control Primary prevention of diabetes complications involves maintaining near normal blood glucose control. Studies show the risk of diabetes complications decreases by up to 76% when average blood sugar levels are maintained at or below 155 mg/dl or a glycosylated hemoglobin A1C level of 7.4%. This study shows that for every 30 mg/dl drop in blood sugar the risk of complications was reduced by 40%. Assessments of glycemic control were conducted on 854 people with diabetes to define long and short term blood glucose levels. This information was compared to physician and patient survey findings to identify factors contributing to poor glycemic control. 62% of patients surveyed felt their average blood sugar level was well controlled (between 70-150 mg/dl). 13% of people with diabetes screened had blood sugar levels within normal limits. 36% of patients screened had fasting blood sugars over 200 mg/dl. 41% had dangerously high blood sugar levels, (average blood sugar levels above 235 mg/dl) or a mean total glycosylated hemoglobin of over 11%. The highest rate of uncontrolled diabetes was found among patients between 0-64 years of age, nearly half had dangerously high blood sugar levels (53% of IDDM and 45% of NIDDM had average blood sugar levels over 235 mg/dl). The risk of diabetes complications increase proportionally with the length of diabetes and level of blood sugar control. This would indicate that we can expect the rate of diabetes complication to continue to increase until we are able to get blood sugar levels under control at an earlier age. Return to top of page Self Blood Glucose Monitoring Studies have demonstrated that the glycemic control levels improve with the frequency of blood sugar testing. Monitoring blood glucose levels is an essential part of maintaining blood glucose levels. People with diabetes should be trained to use self blood glucose monitoring information to self-adjust diet, exercise and medical therapy and identify hypo- and hyperglycemia. This encourages the patient to assume greater responsibility for self control behaviors. This will in turn improve confidence and self management skills and in turn reduce diabetes related hospitalizations. The American Diabetes Association Clinical Practice Recommendations state that blood glucose monitoring should be conducted at least four times per day for optimal levels of control. Testing of long term glycemic control should be conducted every three to six months with the glycosylated hemoglobin assay. 21% of physicians indicated they do not use the glycosylated hemoglobin test to measure long term blood sugar levels. 46% of diabetics surveyed reported they self monitor blood glucose levels less than once per day, 19% once a day, 20% test twice per day, 13% test three to four times per day. The primary reason stated for not testing blood sugar levels was lack of education. Respondents indicated they did not need to test blood sugar levels and they had not ever been shown how to test. Many indicated someone else did it for them occasionally. Less than one third of the respondents indicated cost was a prohibitive factor to testing. Return to top of page Self Care Education Physicians responding to the survey indicated the main barrier to care was a poor patient compliance. Studies have shown that compliance with diabetes control improves proportionally with the amount of diabetes self care education. Hospitalization rates for people with diabetes have been reduced by up to 75% by referring patients to diabetes self care education programs. 57% of diabetics surveyed had not attended any form of diabetes education class. 30% of physicians surveyed do not refer diabetics to education programs. 84% of diabetics surveyed had not attended the two or five day diabetes education class. 75% of physicians were not aware that reimbursement was available from Blue Cross Blue Shield, Medicare and Medicaid to cover the costs of the two and five day diabetes education class. Blue Cross has even dropped its deductible to encourage referrals to these programs. Return to top of page Medical Nutrition Therapy Medical nutrition therapy is an essential component of successful diabetes management. The goal of nutrition therapy is to educate people with diabetes to make changes in nutrition and exercise habits and to improve metabolic control by balancing food intake with medications and exercise. These goals include: maintaining near normal blood sugar levels, optimal serum lipid levels, maintaining reasonable weight and growth, preventing acute glycemic complications and improvement of overall health through meal planning and nutrition education. People with diabetes appear to understand that meal planning is an important part of glycemic control. Eighty seven percent of diabetics surveyed report that they are more careful with what they eat since being diagnosed with diabetes. 21% of the diabetics surveyed had not seen a dietitian since being diagnosed. 56% have not seen a dietitian in two years or more. 38% have not seen a dietitian in three years or more. 45% do not follow a meal plan. Only 79% could recall the calorie level of their meal plan. Compliance rates to meal planning was shown to decrease with the frequency of registered dietitian (RD) visits (72% compliance one year after RD visit to 43% compliance four years after last RD visit). Blue Cross/Blue Shield and Medicaid reimburse the costs of medical nutrition therapy up to four visits per year. Return to top of page   THE INVISIBLE EPIDEMIC | LEARN MORE ABOUT DIABETES | THE IMPACT OF DIABETES | ORGANIZATIONS THAT CAN HELP | BACK TO HEALTHWORKS MAINPAGE © 1998 Prairie Public Broadcasting, Inc.