The bottom line - stay lean and stay active: Numerous clinical trials have shown that type 2 diabetes is preventable with lifestyle changes. Ninety percent of type 2 diabetes cases are attributable to excess weight, lack of exercise, a less-than healthy diet, smoking, and excess alcohol, according to a Nurses' Health Study. Smokers are 50% to 90% more likely to develop diabetes than nonsmokers, according to an American Journal of Public Health study. It is never too late to take charge of your health to delay or ward off getting diabetes!

If you are diagnosed with diabetes, your doctor will work with you to help you keep it under control and avoid complications. In addition to daily checks of your glucose level, following your medication schedule, and the lifestyle changes outlined above, your health care team should ensure you get yearly eye exams, have annual urine tests, monitor your cholesterol levels and oral health, keep your vaccinations up to date, and check your feet daily for discolorations, swelling, pus or unusual changes. These disease management interventions will be critical to your quality of life and longevity.

GIC Health Plans Offer Diabetics a Variety of Programs to Keep Them Healthy

Commonwealth Indemnity Plans: Members with diabetes receive personalized programs, which may include an intensive two-and-a-half days diabetes education program, quarterly individualized recommendations, educational materials and/or a personal nurse health educator who can provide education and support. Contact 1-800-942-7224 for additional details.
Fallon Community Health Plan: Members with diabetes receive telephonic support by a Registered Nurse, as well as educational mailings. For additional details, contact 1-800-833-2535 ext. 69490.
Harvard Pilgrim Health Care: Members with diabetes can take advantage of MyDiabetes, an online support program offering an interactive diary and an online forum. For additional details, contact 1-888-888-4742 ext. 38230 or register on HPHC's website.
Health New England: Members with diabetes can take advantage of HNE's disease management workshops, educational materials, and virtual education programs. HNE's Living Well Grocery Store Tour™ provides members with shopping education at Big Y supermarkets. A licensed registered dietician helps you review food labels for carbohydrate, sodium, fat and cholesterol content to help you make healthy food choices. This tour is also available free to HNE members in VHS and CD-Rom formats. Contact 1-800-842-4464 ext. 3553 for additional details.
Neighborhood Health Plan: Members with diabetes are assigned a Care Manager who provides benefit assistance and patient-doctor support. For additional information call 1-800-432-9449.
Tufts Health Plan: Tuft's Taking Charge™ Diabetes Program helps diabetics take control of their disease with educational materials and patient-doctor support. Call 1-800-870-9488 for additional details.

Diabetes Glossary

Normal fasting glucose level: The American Diabetes Association defines normal fasting blood glucose levels as a value of 110 mg/dL (milligrams/deciliter).
Prediabetes: People with fasting glucose values between 110 and 126 mg/dL are considered to have impaired fasting glucose, or prediabetes, a risk factor for future diabetes and cardiovascular disease.
Diabetic glucose level: People with fasting glucose values of 126 mg/dL or greater may have diabetes and should get additional testing.
Type 1 diabetes: An autoimmune disease in which the immune system attacks the insulin-producing cells of the pancreas. This form of diabetes usually appears in childhood but can occur at any age. Patients must take insulin by injection or pump to stay alive. Approximately 5% to 10% of diabetics have type 1 diabetes. Risk factors for type 1 diabetes may be autoimmune, genetic or environmental. There is no known way to prevent type 1 diabetes.
Type 2 diabetes: A metabolic disorder in which the body's cells become less responsive to insulin, a pancreatic hormone that is essential especially for the metabolism of carbohydrates. Approximately 90% to 95% of diabetics have type 2 diabetes. It is highly preventable with lifestyle changes.
Gestational diabetes: A condition that causes blood sugar to rise in some pregnant women. Blood sugar levels usually return to normal after delivery. However, women who have gestational diabetes are at increased risk of developing type 2 diabetes in the future.

Free Eye Care Program for Diabetics with Medicare (summer 2001)

Diabetes can lead to eye diseases that cause eventual blindness. Detecting eye disease early can ward off debilitating results. Almost 35,000 Medicare beneficiaries in Massachusetts have diabetes. However, a large proportion do not have regular eye exams as a part of a routine diabetes maintenance program.

The American Academy of Ophthalmology (AAO) and American Optometric Association (AOA) have teamed up to offer a program to help avoid blindness associated with diabetes. Their program, called National Eye Care Project, is for diabetics age 65 or older with Medicare. It offers medical and surgical eye care to financially disadvantaged seniors. The program provides medical eye care to all seniors who have not had an eye exam in the last three years. There is no cost to participants; both the deductible and co-payments are waived. Eligible participants receive:
· A comprehensive medical eye exam
· One year of treatment for any condition diagnosed at the initial visit
· No out-of-pocket expense with Medicare coverage

The AOA has also set up a Diabetes Hotline to match patients with participating optometrists in the area where they live. For more information about the NECP, call 1-800-222-EYES (3937). For the Diabetes Hotline call 1-800-262-3947.

Diabetes - The Silent Disease (spring 2000)

More than 15 million people, 5.9% of the U.S. population, have Diabetes Millitus (DM). Diabetes is a chronic disease with no known cure and is the 7th leading cause of death. Particularly troubling is the fact that 34% of the people with DM do not know they have it until they have life-threatening complications. The good news is that DM is a manageable disease when there is cooperation between you and your doctor.

DM is a disease in which the body does not produce, or properly use, insulin, a hormone that is needed to convert sugar, starches, and other food into usable energy. It has two variants:
Type 1- An autoimmune disease in which the body does not produce any insulin, most often occurring in children and young adults. Type 1 accounts for 5-10% of DM.
Type 2- A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. Accounts for 90-95% of DM.

Warning signs of diabetes include:
Type 1: Frequent urination, irritability, unusual thirst, extreme hunger, unusual weight loss, extreme fatigue
Type 2: Any of Type 1 indications, frequent infections (gum, skin, bladder), blurred vision, cuts or bruises that heal slowly, tingling or numbness in the hands or feet

Proper management of diabetes is critical to longevity and quality of life. The National Center for Quality Assurance (NCQA) includes the following points in rating quality health care. If you have diabetes, is your doctor testing the following?
Eye exams: Diabetes is the leading cause of new cases of blindness in people ages 20 to 74.
Foot exams: Approximately 60 to 70 percent of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations.
LDL, Cholesterol and hemoglobin A1c levels controlled: These measurements indicate risk for heart disease, stroke and management of glucose levels. People with diabetes are two to four times more likely to have heart disease, or to suffer a stroke.
Urinalyses for kidney disease performed: Diabetes is the leading cause of end-stage renal disease, accounting for 40% of new cases a year.