Tips to Help Patients Manage Their Care

Dr. John Buse, director of the Diabetes Care Center at the University of North Carolina, Chapel Hill, is president-elect for science and medicine at the American Diabetes Association and a principal investigator in a federal study asking whether blood sugar control can protect against heart disease in people with Type 2 diabetes.
“Diabetes is underdiagnosed, undertreated and underappreciated as a cause of death and disability,” Dr. Buse said. “Despite the fact that almost 20 percent of all health care dollars are spent on the management of people with diabetes, the diabetes epidemic and its associated pain and suffering grow and grow.” Here, he says, are five things that everyone with diabetes should know:
1. If you are overweight, get screened for diabetes with a fasting glucose test, starting at puberty, at least every three years. If you are not, start at age 45. A normal result is less than 100 mg/dl.
2. If you have diabetes or prediabetes, engage in moderate-intensity exercise like brisk walking for at least 30 minutes at least five days a week. If you are overweight, reduce calories with a goal of losing at least 5 percent of body weight (10 pounds if you weigh 200 pounds). Working with a dietitian can be extremely helpful.
3. If you have diabetes, make sure to have an A1C test, which measures glucose levels, at least twice a year, regular blood pressure checks and annual cholesterol checks. The A1C should be less than 7 percent, blood pressure less than 130 over 80 and LDL cholesterol under 100 mg/dl. If you are not reaching all three goals, ask for a referral to a diabetes education program, start a new drug, see a specialist and keep working toward getting what is known as your ABC’s (for A1C, blood pressure and cholesterol) under control. If you are over 21, discuss taking low-dose aspirin with your doctor. Do not smoke.
4. If you have diabetes, have annual checkups for complications including a dilated eye exam by an eye-care professional, a urine microalbumin-to-creatinine ratio and a comprehensive foot exam including testing with a 10-gram filament. If the results are not normal, you will need additional treatment to avoid disability. Make sure you get it.
5. People with diabetes who work with their health care team to do the best they can to control diabetes, its related disorders and its complications should expect to live a long and healthy life.