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Ask Dr. Nancy: Diabetes

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

My mother is a diabetic and so am I. She recently had a stroke and her physician told her that it was a complication of diabetes. What can I do to help her and to reduce my chances of having a stroke?

If you have diabetes then it’s likely you already have or will develop abnormalities, such as fatty deposits, in your blood vessels. Since functioning blood vessels are necessary for providing every cell in your body with nutrients and oxygen, if the blood vessels can’t deliver, then cells die.

There are two categories of vascular disease: macrovascular (larger blood vessels) and microvascular (smaller blood vessels).

Macrovascular complications: Larger blood vessels keep your heart, brain and legs alive. If blood vessels to the heart become blocked, then a heart attack is the result. This is the most common cause of death for diabetics. Blockage of the blood vessels carrying blood to the brain results in a stroke or series of mini-strokes leading to brain dysfunction. Blockage of the blood vessels going to the legs is the primary cause for amputations in diabetics.

What to do? Control of blood lipids and high blood pressure reduces the risk of macrovascular complications. The best approach is to lose weight through healthy diet and exercise. If that’s not going to happen…..then it’s important to know that a recent study led to a reduction in macrovascular complications in the first year for diabetics (age 55 or older) by over 60% with the use of three drugs: Daily aspirin (less platelet clumping on rough areas in the blood vessels), a generic statin (reduces LDL cholesterol and blood vessel inflammation) and a generic ACE inhibitor (relaxes blood vessels and lowers blood pressure) Taking these three medications was an inexpensive way to substantially reduce the risk of disability and death.

Microvascular complications: Smaller blood vessels go to smaller organs including the eyes, kidneys, and nerves. Blood vessel problems in the back of the eye (the retina) are the leading cause of blindness in people with diabetes. Renal failure leading to dialysis results from small blood vessel damage in the kidneys. Nerve damage leading to chronic pain or numbness, called neuropathy, is caused when the small blood vessels no longer deliver nutrients to the nerves.

What to do? Studies have shown that good glucose control to near normal levels is the best defense against microvascular complications. Again, the best way to accomplish this is to reduce calories in and increase calories out. Burn that sugar! Otherwise there are a number of medications that are prescribed to improve blood glucose levels.

The bad news is that diabetes is reaching epidemic proportions worldwide due in no small part to increased availability of food and reduction in the need to move. Following a healthy lifestyle can keep you out of this unfortunate crowd and reduce risk if you are already part of the diabetic group. In addition, take this article to your physician and ask if you could reduce your risk by the treatments noted above.



Dr. Nancy Represents CHP at NCQA Press Conference

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.


On October 22nd the National Committee for Quality Assurance (NCQA) held a news conference in Washington, DC to release “The State of Health Care Quality: 2009.” The report is produced annually to monitor performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement. It also provides an exclusive look at how well the health system performed over the past year in key areas of care and service. Data is drawn from audited data conveyed to NCQA through its Health Care Effectiveness Data and Information Set (HEDIS®) -- the most widely used performance measurement tool in health care -- as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).

Dr. Nancy Van Vessem represented Capital Health Plan at the press conference, which focused on the achievements of a few notable health plans in the country. She highlighted Capital Health Plan’s achievements in Diabetes and Coronary Heart Disease Relative Resource Use (RRU) measures. NCQA will start publicly reporting HEDIS® RRU measures in 2010. These measures, unlike previous HEDIS® measures, assess the efficiency of care delivered by health plans for certain chronic diseases. In general, CHP members require less “rescue” such as inpatient admission and emergency room visits than members in other health plans.

Dr. Van Vessem emphasized that the long-term success of CHP is rooted in its high member satisfaction, high levels of trust, and low disenrollment. This means members with diabetes and coronary heart disease have been involved with local physicians and disease management programs over many years. They have fewer gaps in care attributed to a consistent approach to chronic disease and stable benefits.

“At Capital Health Plan we encourage every member to have a primary care physician. Our goal is to help the physicians manage the chronic disease of their patients,” said Dr. Van Vessem. One of the newest enhancements is that primary care physician offices can access its patients’ information related to gaps in care for a variety of quality measures via CHPConnect. This collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores. Now, that success has continued with notable performance on relative resource use measurements.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).