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Quality Health Care and You - Diabetes

Quality Diabetes Care Goals

The key to quality diabetes care is making sure you're keeping important health measures in the safety zone and getting the routine care you need to prevent complications. These measures are quality care goals and each one has a standard that will put you in that safety zone. Meeting that goal will put you at the very lowest risk for Diabetes complications. In other words it will lower your risk for heart attack, stroke, amputation, blindness, and kidney loss.

The good news is that for each quality care goal there are things that you can do to stay in that zone! For some of the goals it's a matter of knowing what they are and checking with your doctor to be sure you are getting the right tests. For other goals, you can do things at home such as increasing physical activity and getting the help you need to follow the diet that is best for you.

Quality goals that are important to the best diabetes care include:

You can learn more about each of these measures and how they relate to diabetes by clicking on the links above. Talk to your doctor to be sure you're getting the tests and care that are right for you. And, see what you can do at home to get the best quality results.

 

Sugar Control and Hemoglobin A1c

What it is

Everyone's blood contains a sugar called glucose, the main source of fuel to give your body energy. There are two basic ways of measuring blood sugar. The first is direct measurement. The second is a test call Hemoglobin A1c (although they are many names for the same test). The A1c provides an indication of what your glucose has been on the average for the previous few months. It is different from testing your sugar level at one specific moment (like a regular glucose test done at home with the strips).

How it Relates to Diabetes

The best way to avoid or put off the complications of diabetes (damage to kidneys, eyes, nerves, blood vessels, and heart) is to keep your blood glucose as close to normal as possible. As a bonus, you will feel better!

The Quality Standard - How to Know You're Okay

The A1c level that is appropriate for you is a very individual decision. Some organizations such as the American Diabetes Association have recommended that the target level should be less than 7%. However, it is important to recognize that sometimes this cannot be achieved safely so that different levels would be considered acceptable. Your health care provider should be watching your glucose control with this specific A1c test, so make sure you have it done at least twice a year, or even every 3 months, or so.

What You Can Do

There is so much you can do to keep your A1c in the right range. Talk with your doctor about the A1c test, and what the right level is for you. Once you get the test, find out your results, so you can follow your A1c along with your doctor. Finally, the key to keeping your A1c in the right range is your diabetes program: diet, exercise and medicines (insulin or pills). Your A1c shows if you are on track with sugar control or if you need change your program. Keeping it there is the best way to protect your vision, heart and kidneys, decreasing your risk of amputation, heart attack and stroke.

Blood Pressure Control

What it is

As the heart pumps blood through the arteries and circulatory system of the body, it creates a certain amount of pressure on the walls of the arteries. This is called blood pressure.

How it Relates to Diabetes

A whopping 70% of diabetics have high blood pressure, which is a form of cardiovascular disease and the leading cause of early death among diabetics. Sadly, at least 65% of people with diabetes die from some form of cardiovascular disease, commonly heart disease or stroke.

The Quality Standard - How to Know You're Okay

Your health care provider should check your blood pressure at every visit. If they don't, ask them to do it - it only takes a minute. To lower the risk of developing cardiovascular disease, it has been recommended by the American Diabetes Association that diabetics should keep their blood pressure below 130/80 mmHg.

What You Can Do

If you have high blood pressure, talk to your doctor about how it can be lowered using a combination of diet, exercise and medications. Medications can be very effective at lowering blood pressure. The two common classes are called "ACE inhibitors" (such as lisinopril, trandolapril, enalapril) or "angiotensin receptor blockers or ARBs" (such as valsartan, losartan, or candesartan). Staying fit is important too. Your diet and exercise program is good for sugar control and also to keep your blood pressure in the best range.

Cholesterol Control

What it is

Everyone has a certain amount of cholesterol - and it's not always a bad thing. Cholesterol is a waxy, fat-like substance found in all the cells of the body, including blood. There are two kinds of lipoproteins which carry cholesterol through your body: LDL (Low-Density Lipoproteins) or "bad cholesterol" and HDL (High-Density Lipoproteins) or "good cholesterol."

How it Relates to Diabetes

Diabetics tend to have more cholesterol abnormalities. These variances can increase your risk for cardiovascular disease. By managing your cholesterol, especially lowering LDL cholesterol, you reduce your chance of developing cardiovascular disease and early death. In fact, diabetics who lower their LDL cholesterol can reduce their risk of heart attack by up to 42 percent!

The Quality Standard - How to Know You're Okay

Your health care provider should check your blood fat levels at least once a year. Here's what the results should say:

Sometimes diet and exercise aren't enough to bring cholesterol back to normal, and medication may be needed. Statin drugs are one way your health care provider may try to lower your LDL if it is too high.

What You Can Do

Talk to your doctor about getting your blood cholesterol checked and making sure that it's in control. He or she may suggest the use of statin drugs. Increasing physical activity and healthy food choices are also important to keep your cholesterol in the right range.

Weight Control and Body Mass Index (BMI)

What it is

BMI is a measure of the amount of fat in your body. The results are based on height and weight. This test works for both adult men and women.

How it Relates to Diabetes

Being overweight (along with high blood pressure and high cholesterol) increases your risk for cardiovascular disease.

The Quality Standard - How to Know You're Okay

Make sure that your health care provider checks your weight and calculates your BMI at every visit. If they don't, ask them to do it - it only takes a minute. A BMI below 18.5 is considered underweight, 18.5 to 24.9 is normal, 25 to 29.9 is overweight, and 30 or above is considered obese. If you are overweight, it is critical that you begin a plan with your health care team to lose weight (and reduce your risk of cardiovascular disease). Start small - set reasonable goals and make small changes in diet, portion size, and your activity level.

What You Can Do

Make sure that your health care provider checks your weight and calculates your BMI at every visit. If they don't, ask them to do it - it only takes a minute. If you are overweight, it is critical that you begin a plan with your health care team to lose weight (and reduce your risk of cardiovascular disease). Start small - set reasonable goals and make small changes in diet, portion size, and your activity level.

Not Smoking

What it is

Nicotine is one of the most addictive substances known. Most people are exposed to it through smoking, which is very damaging to the body.

How it Relates to Diabetes

Smoking has many bad health effects for everyone. For people with diabetes, who already have a host of health concerns, smoking intensifies the health risks they face, especially when it comes to the risk of developing cardiovascular disease. Smoking raises blood pressure levels, whether you're diabetic or not.

With 70% of diabetics already diagnosed with high blood pressure, smoking only makes it harder to control your diabetes. Smoking also constricts blood vessels. This can cause circulation problems in your feet and can contribute to a heart attack or stroke. If that wasn't enough, nicotine also raises blood sugar levels. It is not yet known whether nicotine addiction causes diabetes, but research on this is currently underway.

The Quality Standard - How to Know You're Okay

Not smoking is the key to this standard.

What You Can Do

Stop Smoking! There's no way around it. Make a plan to quit - start by setting a quit date. Ask your family, friends and co-workers for support. There are medications out there that can help you, so get help from your doctor if you feel you want it. Keep trying even if you're not successful the first time. Don't give up - your health depends on it!

Screening for Kidney Disease

What it is

People with diabetes are at a higher risk for kidney disease. This is because when there is too much sugar in the blood, the kidneys try to clean it out. Unfortunately, the sugar that the kidneys clean out begins to slowly kill the cells in the kidney.

To measure how well the kidneys are working, your healthcare provider should do a microalbuminuria test, which looks for small quantities of protein called albumin in a urine sample. High levels of the protein albumin in the urine indicate the start of a condition called microalbuminuria. Usually, this test is for a person who's been diabetic for several years and may show whether or not you are at risk for developing kidney disease.

How it Relates to Diabetes

Damage to the cells and blood vessels in the kidneys affects their ability to filter out waste. Waste in the blood will stay in the body instead of being excreted with urine. If the damage goes on long enough, in some cases this can lead to kidney failure. When the kidneys fail, every few days a person has to have his or her blood filtered through a machine (a treatment called dialysis), or get a kidney transplant.

The Quality Standard - How to Know You're Okay

Your microalbumin (a protein in the urine) should be less than 30 mg/24 hours. Your health care provider should check this at least once a year. Your doctor can also do a yearly blood test to measure your kidney function.

What You Can Do

Ask your doctor about your kidney function and be sure you are tested at least once a year. All the things you do to care for diabetes are important to protect your kidneys including exercise, diet and your medication program.

Eye Examination

What it is

At a complete eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye. This exam may not be part of an eye exam for a new pair of eyeglasses or contact lenses. Be sure to ask your eye doctor for a dilated eye exam.

How it Relates to Diabetes

Diabetes that isn't controlled may cause blindness. High blood glucose and high blood pressure cause small blood vessels to swell and leak liquid into the retina of the eye, blurring the vision. This can eventually lead to blindness. People with diabetes are also more likely to develop cataracts - a clouding of the eye's lens, and glaucoma - optic nerve damage.

The Quality Standard - How to Know You're Okay

Have a dilated eye exam with an optometrist or ophthalmologist at least once a year. To have this kind of exam, your doctor will need to put drops in your eyes and wait while your pupil dilates - or gets big - to see the back of the eye (the retina). He or she will be able to see whether there is a sign of damage due to diabetes.

What You Can Do

The most important thing to protect your vision when you have diabetes is to keep your sugar in control. Be sure to have a dilated eye exam with an optometrist or ophthalmologist once a year. Remember, it's not enough to have your eyes checked for glasses or contacts, or to have a regular doctor look at your eyes. Also, if you have a change in your vision, see your eye care doctor right away, even if it's not time for your regular check up.

Foot Examination

What it is

Your health care provider will have you take off your socks and shoes. They look over your feet to see if you have cuts or breaks in the skin, or have an ingrown nail. They will ask you if your foot has changed color, shape, or just feels different (for example, becomes less sensitive or hurts). Your health care provider may trim your corns and calluses or toenails if you are unable to do so safely.

How it Relates to Diabetes

People with diabetes are more likely to have foot problems. This is because of the damage that is done to your blood vessels and nerves when blood sugars are not properly managed. Some of the problems people with diabetes may develop include: nerve damage, circulation problems, and infections. These can cause serious foot problems for people with diabetes. Apart from people who have injuries, diabetes is the leading cause of amputation.

The Quality Standard - How to Know You're Okay

People with diabetes should have their doctor check their feet once a year with a special tool to make sure they have feeling.

What You Can Do

The best way to avoid amputation is to keep your sugar in control. Wash your feet every day and dry them carefully, including between your toes. Keep your toenails trimmed if you can do it yourself or, if not, get someone to help you. Keep your feet protected with shoes and socks. Remember, you may not feel things that could hurt your feet, like hot and cold so be sure to take extra care. For example when you wash your feet, test the water, to be sure it's not too hot. Also, check your feet daily and keep track of any changes in color, shape, or feeling in your feet and report them to your health care provider immediately.

Vaccine to Prevent Pneumonia

What it is

Vaccination is giving a person a shot that helps them to be at least partly immune to certain germs. The pneumonia shot helps prevent pneumonia caused by certain kinds of bacteria.

How it Relates to Diabetes

People with diabetes are more likely to develop infections and do much worse when they do get them. People with diabetes are much more likely to have complications when they get the flu or pneumonia. So it's important that you get all of the vaccines you need. Vaccination lowers the risk of catching some diseases caused by germs.

The Quality Standard - How to Know You're Okay

Every year your health care provider should give you a flu shot. You should only get a pneumonia shot once, after you've been diagnosed.

What You Can Do

Check with your doctor to get your flu shot every year and be sure you have had a pneumonia shot.

For more information:

Go to the Quality Health Care and You - Diabetes health topic, where you can:

This article is a NetWellness exclusive.

Last Reviewed: Dec 07, 2012

David C Aron, MD, MS David C Aron, MD, MS
Professor of Medicine
School of Medicine
Case Western Reserve University

Bette K Idemoto, PhD, RN, ACNS-BC, CCRN Bette K Idemoto, PhD, RN, ACNS-BC, CCRN
Clinical Nurse Specialist
Frances Payne Bolton School of Nursing
Case Western Reserve University