Joslin Diabetes Center At Providence: Helping Diabetics Live Longer, Healthier Lives
A message from the Joslin Diabetes Center At Providence:
Diabetes is a chronic disease in which the body does not produce or does not properly use insulin, a hormone needed to convert sugar, starches and other food into energy. It is the fifth deadliest disease in the United States and, while death rates from heart disease, stroke and cancer have declined, deaths associated with diabetes have risen 45 percent since 1987.
"The prevalence of both type 1 and type 2 diabetes is increasing worldwide," says Suchitra Zambare, MD, endocrinologist with the Joslin Diabetes Center Affiliate at Providence and Providence Park hospitals. "But we expect type 2 diabetes to rise more rapidly in the future because of increasing obesity and decreased activity levels."
Type 1 diabetes ("juvenile-onset") is caused by genetic, environmental and immunologic factors that ultimately destroy the pancreas, which produces insulin. It accounts for 5 percent to 10 percent of all diagnosed cases of diabetes. Type 2 diabetes is caused by insulin resistance due to genes and obesity, impaired insulin secretion and increased hepatic glucose production. Type 2 accounts for 90 to 95 percent of diagnosed cases.
According to the American Diabetes Association (ADA), 23.6 million people, or 8 percent of the population, have diabetes; of those, 5.7 million are undiagnosed.
"There is a need for increasing awareness of early diagnosis and treatment of diabetes," says Dr. Zambare, because:
- A large number of individuals who meet the current criteria for diabetes have no symptoms and are unaware that they have the disease.
- Type 2 diabetes may be present for up to a decade without diagnosis.
- As many as 50 percent of individuals with type 2 diabetes already have one or more diabetes-specific complications at the time of diagnosis.
- Treatment of type 2 diabetes may favorably change the course of the disease.
The risk of diabetes increases for certain ethnic populations (African American, Native American and Hispanic) and with age. The ADA recommends diabetes screening every three years for all individuals over the age of 45, and screening of those with additional risk factors, including
- family history of diabetes
- obesity
- history of diabetes with pregnancy
- hypertension
- polycystic ovary syndrome
- history of vascular disease
Although there is currently no screening available for type 1 diabetes, type 2 can be detected with a fasting glucose test. Guidelines identify a fasting blood glucose level between 100 and 125mg/dl as pre-diabetes; fasting blood glucose levels of 126 mg/dl or higher indicate diabetes.
"Type 2 diabetes is preceded by a period of impaired glucose tolerance. At this stage, a number of lifestyle interventions, such as diet change and weight reduction, along with medications, can prevent or delay the onset of diabetes," says Dr. Zambare. "That's why early diagnosis through screening is so important."
Persons with diabetes are at increased risk for serious, even life-threatening, complications, but keeping diabetes under good control can help reduce that risk. Complications of diabetes can include eye disease, like retinopathy, cataract, glaucoma; neuropathy (nerve involvement); sensory and motor difficulties; kidney disease, which may lead to dialysis; coronary disease (heart attack); peripheral vascular disease, which can lead to limb amputation; stroke; diarrhea and other gastrointestinal problems; repeated yeast infections.
Fortunately there is effective, long-term treatment for diabetes. The Joslin Diabetes Center is the national leader in the clinical care, treatment and research related to diabetes and its complications. Providence Hospital's affiliation with this nationally recognized institution enables us to offer our patients the highest level of diabetes care.
We take a multidisciplinary approach to diabetes care, bringing health care professionals together to provide care and education that can significantly improve the lives of patients with diabetes.
Our team includes:
• Board-certified endocrinologists
• Certified diabetes educators
• Registered dietitians
• Adult nurse practitioner
• Clinical support staff
The patient's participation, input, and enthusiasm are central to the success of this team and vital for optimal diabetes control.
"We provide patient education on self-monitoring of blood glucose, insulin administration, diabetes management during sickness, management of hypoglycemia, foot and skin care, diabetes management before, during and after exercise, risk-modifying activities, and medical nutrition therapy," says Dr. Zambare.
"We educate our type 1 diabetics about the insulin pump, get them started on the pump and give them continuous support and follow-up. The insulin pump has made diabetes control so much better for those with type 1 diabetes, and we have a dedicated staff member just for those issues."
There are new developments in diabetes management, including many new drugs to help decrease insulin resistance and reduce blood sugar levels without causing hypoglycemia. The newest beneficial technology is continuous glucose monitoring that shows glucose patterns throughout the day without repeatedly poking the patient for blood.
"At Joslin and Providence, we pride ourselves on providing comprehensive diabetes care in tune with the latest technology," says Dr. Zambare.
