The
ABC's of Diabetes Care
By: Dr.
Stefanie Kelley
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.
|
