Mankato Clinic implements iD5 initiative to improve diabetic control in diabetic patients
Just 25 years ago, a diagnosis of Type 1 diabetes in adolescence meant a life expectancy of around 40, and a diagnosis of Type 2 diabetes in adulthood meant limb amputations, blindness, kidney failure or even early death. But, times have changed. Today, thanks to advances in research, education and technology, better diabetes health can be attained. One way Mankato Clinic is working to help its diabetic patients attain better diabetic control is with a new initiative at its’ North Mankato Family Practice Clinic called iD5. iD5, or Initiative Diabetes 5, seeks to improve diabetic control by pinpointing five target goals. The program benefits both Type 1 and Type 2 diabetics.
The five goals for living well with diabetes are:
1. Control blood pressure - High blood pressure makes the heart work too hard. It can cause heart attack, stroke and kidney disease. Ideal blood pressure in a diabetic patient is less than 130/80.
2. Lower bad cholesterol – LDL, or bad cholesterol, can build up and clog blood vessels and can cause heart attack and stroke. HDL or good cholesterol helps remove cholesterol from blood vessels. Diabetics should strive for LDL less than 100.
3. Maintain blood sugar - High blood glucose levels (too much sugar in the blood) may harm the heart, blood vessels, kidneys, feet and eyes. Hemoglobin A1C, which measures the average blood sugar level over a three to four month period, should ideally be less than 7 percent in diabetic patients, which is equivalent to a daily average blood sugar of 154 mg/dL.
4. Be tobacco-free - Smoking doubles the risk of heart disease. It may also damage the blood vessels in the legs, increasing the risk of amputation. Smoking increases the cardiovascular complications associated with diabetes including heart disease, stroke and peripheral vascular disease.
5. Take an aspirin daily – Taking aspirin every day can help to reduce the risk of heart disease and stroke.
Christie Nelson, registered nurse and chronic care coordinator at Mankato Clinic-North Mankato Family Practice, works with the clinic’s diabetic patients and tracks their well-being. “Following and meeting the iD5 goals is important for patients managing diabetes long term,” said Nelson. “There is evidence-based data that shows following these goals helps reduce the risk of heart attack and stroke in individuals with diabetes. Because diabetes is a chronic disease and individuals with a chronic disease will never be cured, those who manage their disease in a healthy way have a good chance of living a long, quality life.”
Nelson is part of a team including the provider, the primary nurse and the department specialist that provides a medical home to coordinate all of the patient’s diabetic needs. She says patients sometimes need a little extra motivation, like a phone call to keep them on track. “The team keeps a registry of diabetic patients and if any of them do not meet any of the five targeted goals, we ask to see them back within a certain amount of time,” said Nelson. “The electronic registry alerts us if any patients are overdue and we give them a call to check in and schedule an appointment. I serve as a patient contact and inquire about side effects, make changes to medications per the patient’s provider, motivate patients in their efforts to achieve weight loss and healthy eating goals, and coordinate with medical specialists and community resources to support patient needs.”
Shirley Zimpritch, a 74-year-old Type 2 diabetic from Elysian, began working with Nelson and the medical staff at North clinic over six months ago after experiencing dangerously high blood sugars as a result of taking prednisone prescribed by another medical facility. She began taking insulin to control her blood sugars and Nelson, in conjunction with the physicians at North, began following her two to three times a week to make sure she was staying on track.
“My experience with the medical staff at North Mankato Clinic has been super,” said Zimpritch. “It makes me comfortable knowing that Christie is going to call and check in on me to see if my needs have changed and that I can call the medical team at any time when I need them. They simplify what I need to do in order to stay in good diabetic health and encourage me to stay under control. I am feeling better as well as seeing on paper that my complications are improving.”
Dr. Andy Miller, family practitioner at Mankato Clinic-North Mankato Family Practice, says that the iD5 concept stemmed from the health care home model and is part of the clinic’s team approach to diabetes care. “iD5 came from the idea of getting a nurse coordinator involved to keep better track of diabetic patients and in the end, get more patients to reach their goals and achieve better control overall,” said Dr. Miller. “Our medical home team is able to spend extra time with patients who need a little more attention which provides a team approach to medical care. Patients seem appreciative of the extra time and follow-through.”
Stacy Hogan, a Type 1 diabetic for 20 years, uses an insulin pump to help control her diabetes and has additional diabetic complications to manage. She says iD5 has helped make her goals more understandable and taught her how to implement the five goals into everyday life. Her blood pressure and A1C have both come down since she started following the goals.
“iD5 helps simplify what I should be shooting for to get better control of my diabetes,” said Hogan. “The last 15 years I was in denial about having diabetes and I blew it off thinking I was invincible. I really thought it would be a long time before I would start seeing complications. But because I didn’t do the things I needed to do to keep my diabetes in control, I am now suffering from kidney disease, neuropathy, seizures and visual problems. Christie follows me closely, coordinates my specialty care and actually breaks down my condition and needs into one summary so I can better understand it all.”
Dr. Miller says having specific goals to shoot for makes diabetic control more manageable for many patients. “iD5 helps clarify for the patient what we think is important for living healthy with diabetes,” said Dr. Miller. “It is geared toward the diabetic patient who is not at goal but is helpful to any diabetic patient to make sure they are sustaining goals. Meeting these five targeted goals, helps lead to successful diabetic control.”
Diabetes Mellitus is a condition in which a person has a high blood sugar (glucose) level as a result of the body either not producing enough insulin, or not responding to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose and convert it to energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood leading to hyperglycemia and various potential medical complications.
Most people have heard of diabetes, but many may not realize that there is more than one kind. The two most common types of diabetes are:
Type 1: Type 1 results from the body's failure to produce insulin, and requires a person with diabetes to inject insulin to move sugar from the bloodstream to survive. This type of diabetes is an autoimmune disorder, which may be triggered by a virus or other factors. Type 1 can start at any age but many cases begin in childhood, adolescence or early adult years. It is usually diagnosed before age 40. Only 5 to 10 percent of people with diabetes have this form of the disease.
Type 2: Type 2 is the most common form of diabetes. It results from a relative deficiency of insulin and insulin resistance, a condition in which cells fail to use insulin properly. Type 2 diabetes occurs when insulin that the body produces is less efficient at moving sugar out of the bloodstream resulting in a high blood sugar. Experts once considered Type 2 diabetes as the adult onset type of diabetes. However, many children are now being diagnosed with Type 2 diabetes as the obesity epidemic grows. Diet, exercise, weight loss, and, in some cases medications and insulin, are the treatment for this type of diabetes. This type is often associated with physical inactivity and obesity.
For more information about iD5 or to schedule an appointment with a member of the medical team at the Mankato Clinic please call 507-625-1811.