D
ay one, first patient, at a neurology
private practice here in Louisville:
the doctor and I walk into his office where the patient waits. Mr. G is a nice
and anxious 48-year-old man seeing a neurologist for the first time. His story unfolds.
“I was diagnosed with diabetes and given
medicine, Metformin, by my primary care
doctor. I thought if I took the medicine the
diabetes would be taken care of.” The neurologist responds, “like
penicillin.” Patient, “You would think.”
I’m not sure how long this man has been living with diabetes.
Nor do I know the conversations that have occurred with him
and his primary care physician. He presented to the neurologist
for treatment of his diabetic peripheral neuropathy. He complained of pain and tingling in both feet up to his mid-calf. His
PCP had increased his Metformin dosage, placed him on Lyrica,
and referred him to a neurologist.
Kidney disease, vision loss, gastroparesis, increased risk of
infection, cardiovascular disease, stroke, impotence, pregnancy
complications, and nerve damage are potential complications
of diabetes. All of that is common knowledge to a physician
but not so common knowledge to the patient population. In
2011, the CDC reported that diabetes affected 8.3% of the US
population. 8.3% of the US population is 25.8 million people,
of which 7 million are undiagnosed. The 7 million may or may
not have access to health care and may or may not be concerned
about having diabetes. One way or another they will end up
in a hospital due to complications. Treatment will range from
insulin to dialysis to leg amputation. The CDC reported that the
estimated total (direct and indirect) cost of diabetes in 2007 in
the US was $174 billion. The estimated total cost rose to 245
billion in 2012. That is a 41 percent increase in five years. It is
estimated that people with diabetes have health care expenses
2.3 times higher than those without diabetes.
subtracting processed food, sugars and sodas go a long long way
towards improvement. Annual membership for a single adult at
a Louisville YMCA is around 700 dollars. However, that price
is flexible based on household income, and families receive a
better deal. Imagine the health benefits and money saved, for
less than $1000 a year: less than a hospital stay, less than dialysis
treatment, less than brand-name insulins. There are even cheaper
fitness classes at the local Family Health Centers of Louisville.
The Family Health Centers also offer free and low-cost health
education classes focusing on diabetes prevention and management. We have farmers’ markets scattered about Louisville,
with cheap vegetables, food to taste, and recipes to teach. The
resources are available.
Health care is a two way street. The physician and patient
must meet in the middle for effective health care. Treating lifestyle diseases requires more from both sides. Physicians need
to advocate, educate, and motivate. Patients must listen, learn,
and participate. We don’t know the conversations that happen
behind closed doors between a physician and her patients.
Mr. G expected a pill to cure his diabetes like penicillin cures
strep throat. Maybe his PCP tried to teach him about lifestyle
modifications needed to fight diabetes because the pill isn’t a
cure. Maybe Mr. G didn’t listen. On the other hand, maybe his
doctor did not take time to educate. We don’t know, nor do we
need to know. As physicians it is our tenet to do no harm. If
we do not educate and inform then are we doing harm? Even
if only 1 out of every 20 patients listens and acts upon lifestyle
modifications to lend a hand in treating his disease, then that
is one more person reaping the benefits of a longer, healthier
life. And by golly you have saved the taxpayers, hospitals, and
government some money. LM
Note: Anna Cooper is a third-year medical student at the
University of Louisville.
It is no surprise that diabetic management is costly and timeconsuming. There are several physiologic and genetic factors
that play a role in diabetes, and many therapies are used for
diabetes and its complications. The class of treatment that has
few (if any) side e