The Benefits of Improved Glycemic Control
March / April 2006
Comprehensive diabetes care promotes better outcomes
for patients.
“Glycemic control is critical to the long-term welfare
of diabetic patients,” says Mark
Schutta, MD, Medical
Director of the Penn Rodebaugh Diabetes
Center and Assistant
Professor of Medicine at the University of Pennsylvania School
of Medicine. According to a December 2005 article in the New
England Journal of Medicine, controlling glycemic levels
reduces the risk of early microvascular complications, such
as retinopathy, nephropathy and neuropathy, as well as macrovascular
complications, such as myocardial infarction and stroke.
This
is particularly pertinent because cardiovascular disease “is
the chief cause of death among patients with either type
1 or type 2 diabetes” (NEJM, Vol. 353, No. 25).
Further, the study on which these findings are based also
found that while the patients’ glycemic levels were
only followed and treated for 6.5 years, the beneficial effects
of this close monitoring persisted during another decade
of follow-up (Journal Watch, Jan. 6, 2006).
Straightforward and Complex Cases
It may, however,
be challenging for a primary care physician to have the resources
to closely follow a patient’s
glycemic levels. “No matter how severe their diabetes,
we need to be vigilant about the variables that come into
play when patients are trying to maintain adequate glycemic
control,” says Dr. Schutta. “This can mean monitoring
activity levels, noting the quality of food they eat and
following how they administer their medications. A primary
care physician might not have the time or staff to devote
to monitoring patients in this kind of detail.”
Offering the region’s only comprehensive diabetes
center, the Penn Rodebaugh Center is
devoted to the treatment of these patients, from those who
present as a straightforward diabetes case to those who have
various co-morbidities. “Our
multidisciplinary approach enables us to handle everything
from the basic to the more complicated cases,” says
Dr. Schutta. “For example, we have patients who need
or have had organ transplants as well as those with multiple
complications. We have experience working with their primary
care physicians as well as cardiologists and others involved
in the patients’ treatment to ensure they receive the
best possible care.”
In fact, the Penn Rodebaugh Diabetes Center does not offer
primary care but rather works closely with referring physicians
on individual cases. “If the patient presented with
cancer, it would make sense to consult an oncologist. So,
if the patient presents with diabetes, it makes sense to
consult an endocrinologist,” says Dr. Schutta. “As
part of our efforts to improve glycemic control, we often
ask patients to contact us regularly with their blood sugar
levels. Our staff will review them within 24 hours and suggest
changes that will demonstrate better results.”
Access to Latest Treatments
As an active participant
in research and clinical trials, the Penn Rodebaugh Diabetes
Center offers patients access to various research studies
conducted by its faculty and scientists within Penn’s
Division of Endocrinology, Diabetes and Metabolism. In fact,
the Hospital of the University of Pennsylvania is one of
the few nationwide centers conducting islet cell transplantation
therapy for type 1 diabetes. This procedure may represent
the first potential cure for the disease.
“We have access to many new, FDA-approved therapies
before they are brought to market, which can be very beneficial
for our patients,” says Dr. Schutta. “In addition,
we are very involved in diabetes research. We’re even
conducting research about diabetes education. It seems some
patient demographics do better with different forms of diabetes
education. If we determined how one patient type learns best,
we could develop an educational program specific to his or
her level of education or background. This would make learning
and understanding how to cope with the disease more effective
and ultimately help the patient learn to better monitor his
or her own food intake and activity levels.”
Patients of the Center are required to enroll in a 10-hour
diabetes education program, which includes one, one-hour
session with the program director as well as three, three-hour
group sessions. In addition, medical nutrition therapy is
an important component of treatment. Patients meet one-on-one
with a registered dietitian/nutritionist (who is also a Certified
Diabetes Educator) to learn how to appropriately balance
healthy eating, exercise and medication. The Center’s
medical nutrition therapy program caters to patients with
types 1 and 2 diabetes as well as those with gestational
diabetes. An advanced course for patients using insulin while
on a carbohydrate-conscious diet is also available.
For the convenience of patients, the team, which includes
nutritionists, endocrinologists, specially trained nurses
and a podiatrist, is available all in one location.
“The team sits down together twice a month to review
cases,” says Dr. Schutta. “Our team approach
as well as our standing as a predominant research center
enables us to provide patients with the latest state-of-the-art
pharmacologic therapy as well as other treatments and technology
to deal with this disease.”
For more information, visit the Penn
Rodebaugh Diabetes Center web site.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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