Few Diabetics Receive Education Considered Vital
By Bill Zeeble, KERA 90.1 reporter
Dallas, TX – Bill Zeeble , KERA 90.1 reporter. A growing number of people around the world are recognizing these symptoms: they?re a little overweight; not as active as they used to be; and, on occasion, suffer blurry vision and fatigue. They may be using the bathroom more than ever, or a cut on their foot isn?t healing the way it used to. Eleasar Gil, now 62 years old, found himself with some of these problems ten years ago. Eleasar Gil, patient: The doctor said my diabetes was the cause of sleepiness, loss of energy, eyesight.
Zeeble: Gil, who lives in south Texas near the border, says he didn?t learn much more than that about his condition
Gil: At the beginning, diabetes was just diabetes. I paid no attention. I was [a] 260-pound man, and I found myself at 170 pounds. That was my diabetes. I paid no attention to it.
Zeeble: Every day, 2,000 Americans get this metabolic disease that is a leading cause of amputations, blindness, deadly kidney and heart disease, and nerve damage. Like Gil, most of these are type-2 diabetics, who can usually manage their disease with exercise, a healthy diet, and maybe a some pills. Gil says he finally got adequate diabetes education not from his doctor, but from volunteer diabetes educators. They warned him of consequences from the uncontrolled illness.
Gil: Thanks to them, I paid attention to my diabetes. If not for them, maybe I?d be dead by now.
Zeeble: Because diabetes is a chronic - that is, long-term - disease, experts, like Phoenix educator Betty Brackinridge, say education is indispensable for managing it. As with other chronic ailments like asthma or Parkinson?s disease, most of the daily care falls to the patient, whether the diabetic patient is a type-2, or type-1, where insulin injections are a must.
Betty Brackinridge, Diabetes Management Training Center, Phoenix, AZ: Expecting people to live successfully with diabetes, without providing education, is something like giving someone a job to fly a 747, handing them a book, and sending them out to the tarmac.
Zeeble: Brackinridge says there are simply too many aspects of this disease to keep track of, from scheduled blood tests, measured meals and exercise plans; to working with other family members, colleagues and physicians; and handling stress and medical emergencies. A so-called best practice for diabetics these days involves teamwork. There?s the doctor, who?s usually too busy to teach patients all they need. So there?s also a nurse-educator, a psychological counselor, foot specialist, and others, including a dietician, like Kara Gan. [Ambient sound.] She?s teaching half a dozen newly-diagnosed young diabetics and their parents in a class at Children?s Medical Center in Dallas.
Kara Gan, dietician, Children?s Medical Center in Dallas: Always count carbohydrates. I?ll say that again. It?s better to estimate than not count at all. .. sugar is okay in moderation. I like to say that several times, because for so long it?s been thought people with diabetes should avoid sugars at all costs.
Zeeble: Sitting in this weekly class is Connie Turner and her nine year old daughter Alexis, diagnosed with diabetes on Halloween, before the candy, says her mother. She adds there?s nothing more important than diabetes education.
Connie Turner, mother of newly-diagnosed diabetic Alexis: It?s a top priority. Her aunt, and her grandmother and grandfather all have diabetes, not type-1 but type-2. Theirs is so totally different from hers, she can?t follow their guides
Zeeble: In addition to details provided for managing the disease every day, Connie Turner says she?s learned a bigger message that helped ease the fear she had when she and Alexis first arrived.
Turner: She?s a normal kid who has to have extra care for this disease. We can control it. We can do it together. But it takes all of us to handle this.
Zeeble: The problem with this education model, says educator Betty Brackinridge, is that only 20% of U.S. patients receive it. She calls it a national tragedy and blames it, in part, on doctors and their training.
Brackinridge: They?re trying to treat diabetes in the model they were taught in medical school. That acute-care model. They prescribe the medication, and the patient goes off to take it.
Zeeble: Top physicians in the field say it?s time that model changed. Dr. Arun Baksi, from the United Kingdom, recently told doctors and educators at an international diabetes conference in Mexico City, that medical school training is obsolete.
Dr. Arun Baksi, diabetes specialist, Isle of Wight, U.K.: We are rarely taught how to teach. .
Zeeble: Baksi calls some doctors hypocrites for saying they want to better educate their patients, then doing nothing about it. Doctor Bernard Zinman, medical professor at the University of Toronto, isn?t that harsh towards his colleagues, but admits there?s truth to Baksi?s charges.
Dr. Bernard Zinman, Professor, University of Toronto: I don?t think physicians are being appropriately apprised of the importance of education of diabetes, but I think that?s also changing. I don?t think physicians are noted for their ability to change what they?ve been doing for many years. Unfortunately, we do have doctors still practicing medicine they learned in the 1960?s.
Zeeble: As a result, says Dr. Christopher Saudek, incoming President of the American Diabetes Association, too many physicians lack important knowledge about the nation?s seventh leading cause of death. Many still downplay long-term effects, perpetuating old-time phrases like ?borderline? diabetic, or a patient with, quote, a touch of sugar. He says that leads many patients to ignore the disease.
Dr. Christopher Saukek, incoming President, American Diabetes Association: And there?s no question many health professionals don?t take it seriously. A ?touch of sugar? is out of line. There?s no such thing. You either have it or you don?t
Zeeble: While some physicians believe they can adequately handle newly-diagnosed patients, Karen Linder says it?s not that easy. A diabetes educator at Children?s Medical Center in Dallas, she ends up getting those patients.
Karen Linder, certified diabetes education, Children?s Medical Center in Dallas:They come in, treated by their practitioner, who thought they could do it. The kid comes in with poor control, and complications can set in. A lot of times, they?ll say, ?I?ve worked with the patient; he?s in poor control; now can you take care of them??
Zeeble: That leaves advocates for medical school reform, like Dr. Arun Baksi, saying they must teach by example. Baksi says physicians unwilling to educate patients about diabetes is a worldwide problem. But they?ll change if others are successful at it. That?s why many have copied the methods of diabetes specialist Dr. Jaspar Bajaj of New Delhi. Many of his patients are poor and poorly educated. Instead of telling them to weigh, say, 150 grams of rice or lentils for their planned meal, he tried what he jokingly calls his hands-on approach. He put India?s most used grains on his desk in his office, next to a scale.
Dr. Jaspar Bajaj, New Delhi: Either the patient or the spouse - because the woman cooks in India - were asked to take a fistful, and I put it on the balance to see how much it weighs. The average fist size of the woman turned out to be 28 grams.
Zeeble: So he told his patients, just take five fistfuls of grain, and use that as your measure to cook the meal.
Bajaj: We could then follow up compliance rates, which have improved to nearly 60%. Never a hundred, but still they were more than twice the compliance rates. This hands-on experience, making the fist, is extremely relevant, especially to illiterate and semi-literate populations.
Zeeble: Bajaj says doctors in his country were once reluctant to turn their esteemed offices into a grocery, but not anymore. He and Dr. Baksi say it comes down to successful grassroots efforts. The same way Pima Indians in Phoenix, Arizona are now spreading the word of the disease to their members, instead of leaving it to government officials. The Pima have highest rate of diabetes in the world. The same way there?s a new youth organization created to teach young diabetics in Latin America how to handle the disease. Yet, here in the U.S., especially among family physicians and in rural regions, education still gets little emphasis. Diabetes doctors say it may take several generations to reverse that mindset. For KERA 90.1 I?m Bill Zeeble.