Diabetes takes a staggering toll on society.
One in three Medicare dollars is spent caring for individuals with the metabolic disorder, according to the
American Diabetes Association. An estimated
29 million people in the United States live with the disease, representing about nine percent of the population. In 1958, less than one percent of Americans had diabetes.
Candis Morello, PharmD, professor of clinical pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego, specializes in treating people with diabetes and recently received a Pharmacy Best Practices in Diabetes Care Award from the American Association of Diabetes Educators Pharmacy Community of Interest.
She discussed approaches to care and lifestyle changes that can help prevent or delay the long-term health consequences of the disease, the nation's seventh leading cause of death.
Personalized Care Plans
“The most important first step is to make sure your blood sugar targets have been personalized to your specific health status, age and lifestyle,” said Morello.
A decade ago, health professionals had blanket blood glucose targets for treating diabetes. Before-meal blood glucose levels were to be kept in the 80 to 130 mg/dl range and A1C levels below seven percent. A1C levels are a weighted average of blood glucose values on red blood cells over a two to three month period.
The one-size fits all approach to diabetes care is over. “We now know that hypoglycemia (low blood glucose levels) has its own health risks, including cognitive impairments and cardiovascular complications, as well as increased fall risk for older adults,” said Morello.
With greater understanding of the dangers of hypoglycemia, individuals with diabetes are advised to achieve the best glycemic control that also avoids low blood sugar.
Younger, healthier individuals, for example, may benefit from tighter A1C targets of 6 to 6.5 percent, while older adults or those with multiple health issues that make them prone to hypoglycemia, may benefit from looser targets, in the 7.50 to 8 percent range.
Individualization is key, says Morello.
Combine Diabetes Medications
People with diabetes are at increased risk of blindness, amputations, cardiovascular disease, kidney disease and nerve damage. While in the past there was a very limited number of drugs available for treating diabetes, today there are more than 30 FDA-approved oral, injectable and inhaled medications that target specific physiological pathways in the muscles, liver, stomach, gut, kidneys, brain and pancreas that may be affected by the disease.
“Combining medications is key to protecting the organ systems that are being most affected by your diabetes,” said Morello.
Nutrition and Physical Activity
“I don't have a pill that works better than healthy nutrition and activity,” said Morello.
More than 90 percent of people with diabetes have type 2 diabetes, which is associated with obesity and sedentary lifestyle. Most diabetes can be prevented by lifestyle changes.
“Healthy eating is about quality foods and quantity management (portion sizes),” said Morello.
“I recommend lots of fiber (at least 25 grams a day), colorful vegetables, whole grains and fresh fruits with limited amounts of lean animal protein, alcohol and sodium. Avoid processed foods,
particularly trans fats, and sugary drinks (including fruit juices).”
In terms of physical activity, “If I tell my patients to exercise, sometimes they think they need to run a marathon. You can put on music and dance or go for a swim. Find what you like and try to add some mild strength training to your routine twice a week, if your medical provider approves of this,” said Morello. “You don't have to be afraid of diabetes. We can prevent and delay complications.”
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