Teaching Patients Self-management Skills Key to Helping Them Battle Disease
05, 2014 08:48 pm Chris Crawford (mailto:aafpnews@aafp.org) – Between 1990 and 2010, the number of adults reporting a diagnosis of diabetes more than tripled, from 6.5 million to 20.7 million, outstripping the rate of total U.S. population growth during that period of from 178 million to 226 million. During those 20 years, however, rates of five diabetes-related complications among adults actually declined, according to a study published last month (http://www.nejm.org/doi/full/10.1056/NEJMoa1310799) in the New England Journal of Medicine.In the study, researchers found that the incidence of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke and deaths from hyperglycemic crisis all declined during the designated time period.
“These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., senior epidemiologist in the CDC’s Division of Diabetes Translation and lead author of the study, in an April 16 press release.(http://www.cdc.gov/media/releases/2014/p0416-diabetescomplications.html)
However, Gregg noted, “while the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”
Breaking Down Two Decades of Data
CDC researchers analyzed data from the National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System and the National Vital Statistics System to identify trends in diabetes complications in the United States between 1990 and 2010. The greatest relative decreases in complications were observed for acute myocardial infarction and death from hyperglycemic crisis, both of which declined by about two-thirds, according to the study. Moreover, the largest declines in complications in both absolute and relative terms were observed among those ages 75 and older, with the exception of end-stage renal disease, which declined among people ages 20 to 64 but not in those older than 64.
Researchers pointed to possible reasons for the drop in diabetes-related complications, including an overall increase emphasis on integrated care management for patients with chronic diseases that incorporates team-based care, patient education in disease management and clinical decision-making support paired with enhanced patient self-management of risk factors.
Looking at Next 20 Years
Going forward, family physicians can continue to help patients battle diabetes and its complications by educating them about managing the condition. “Make sure every patient with diabetes is well-educated on the risks associated with diabetes,” said AAFP Health of the Public and Science Medical Director Jennifer Frost, M.D., noting that the Academy’s FamilyDoctor.org website offers patient-education materials (http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.html) that can help family physicians achieve this goal. “The patient-centered medical home provides a model for chronic disease management that will help primary care offices care for these patients.”
The most important strategies to reduce the risk of diabetic complications are to treat lipid disorders and, of course, control blood sugar and blood pressure, Frost said. These strategies can include medications as well as lifestyle modifications, she added. To that end, American Family Physician offers up-to-date, evidence-based information on managing type 2 diabetes and preventing its complications (http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=7)
A CDC study published in the New England Journal of Medicine found that between 1990 and 2010, the number of adults with diabetes more than tripled. At the same time, the researchers found that rates of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke and death from hyperglycemic crisis declined. Researchers pointed to possible reasons for the drop in diabetes related complications, such as an overall increased emphasis on integrated care management for patients with chronic diseases.
Even as Diabetes Prevalence Triples, Rates of Serious Complications Drop — AAFP News — AAFP http://www.aafp.org/news/health-of-the-public/20140505diabetescomps.html
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