Diabetes Registry Enables Safer, More Thorough Care for Patients

**By Nicholas Moy, MD**

MD PatientAccording to a landmark study published in 2016 in The Lancet, 422 million adults worldwide have diabetes. In the United States alone, diabetes statistics are staggering. According to the Centers for Disease Control and Prevention, in 2015:

  • More than 100 million Americans have diabetes or prediabetes, which if not treated can lead to type 2 diabetes within five years.
  • The percentage of adults with diabetes increased with age, reaching a high of 25.2 percent among those aged 65 years or older.
  • An estimated 1.5 million new cases of diabetes were diagnosed among U.S. adults, with more than half between the ages of 45 and 64.
Understanding diabetes by type

In type 1 diabetes, the body does not produce insulin. Insulin is a hormone the body needs to get glucose (sugar) from the bloodstream into cells. Type 1 is usually diagnosed in children and younger people. However, it can develop at any age. Only about 5 percent of people with diabetes have type 1. Currently, there is no known way to prevent type 1. People with it must inject or pump insulin to survive.

In type 2 diabetes, sometimes called “adult onset,” the body does not use insulin properly, which is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time, it isn’t able to keep up and can’t make enough insulin to keep blood glucose at normal levels. People with type 2 can manage the disease with diet, exercise and medications. In some cases, insulin is needed for management.

Preventing type 2 diabetes

Before people develop type 2 diabetes, they almost always have prediabetes – blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.

While there is still no cure for diabetes, there is good news: The progression from prediabetes to type 2 diabetes is not inevitable. The National Institutes of Health clinical trial, the Diabetes Prevention Program, found that for people with prediabetes, modest lifestyle changes led to weight loss of 5 to 7 percent in participants and reduced the risk of type 2 diabetes by 58 percent in individuals at high risk.

Diabetes Registry

This is why primary care physicians with Virginia Mason, including myself, developed a Diabetes Registry, which does three important things to help ensure the right care is delivered to the right patients at the right time. First, it identifies patients with diabetes. Second, it identifies how well they are doing. And third, it pulls them back into care when needed.

Although the American Diabetes Association recommends that people with diabetes see a primary care or endocrinology provider every three to six months, life doesn’t always allow that to happen. This is why Virginia Mason’s  Diabetes Registry software is so helpful. It uses algorithms to regularly analyze electronic medical records and alert care teams about who may need follow-up, whether through an appointment or a report to their care team on recent changes, such as with blood pressure, weight loss, etc.

Virginia Mason team members, including medical assistants and nurses, then know to check in with these patients to make sure they are on track. This ensures the care they receive is aligned with their current needs.

“Recently, I was able to get several out-of-care patients in for an appointment and labs with one of our providers,” said Certified Medical Assistant Courtney Yates. “Patients are responding well to the simple reminders we’re sending them, whether they are messages though the patient portal, calls, or mailed letters. Our goal is to get 100 percent of our out-of-care patients back in care.”

Dr Nicholas MoyNicholas Moy, MD, is board certified in Internal Medicine and practices Primary Care at Virginia Mason Hospital and Seattle Medical Center. His special interests include quality improvement and geriatrics.


Medical Referral to Community Program Can Fight Obesity, Prevent Disease

**By Brandon Auerbach, MD, MPH**

Plus Size Woman Meeting With Doctor In SurgeryAccording to the Centers for Disease Control and Prevention, more than one third of American adults are obese. Among American teenagers, 21 percent are obese, which is up from only 5 percent in 1980.

Obesity directly contributes to the development of more than 25 chronic diseases, such as high blood pressure, diabetes, high cholesterol and heart disease. Obesity also increases the risk of many cancers (e.g., colon, breast, pancreatic, thyroid, esophageal, kidney and gallbladder). This year, the direct medical cost of obesity in the U.S. is estimated to exceed $150 billion.

What is obesity?

Simply put, obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat or water. Both terms mean that a person’s extra body weight is greater than what is considered healthy for his or her height.

Obesity happens over time when you eat more calories than you burn. The balance between calories-in and calories-out differs for everyone, influenced by diet, level of physical activity and genetics.

Thankfully, if you are obese, losing 5 to 10 percent of your weight can prevent the development of chronic diseases like diabetes, or substantially improve existing disease.

Calculating whether you are overweight or obese

Body Mass Index (BMI) is used as a screening tool for determining whether someone is overweight or obese. Click here to access an adult BMI calculator. A high BMI can be an indicator of high body fat.

  • If your BMI is less than 18.5, it falls within the underweight range
  • If your BMI is 18.5 to <25, it falls within the normal
  • If your BMI is 25 to <30, it falls within the overweight range
  • And if your BMI is 30 or higher, it falls within the obese range

At Virginia Mason Primary Care practices, team members weigh and electronically track all patients’ weight so that customized care plans, supported by automated follow-up tools, can be made during primary care visits.

Weight management care plans are different for every person. Virginia Mason has partnered with the YMCA to refer patients with obesity or chronic conditions – like  diabetes or prediabetes – to lifestyle change programs shown in randomized, controlled trials to help patients lose weight, maintain weight loss, and prevent or reverse diabetes and prediabetes.

The YMCA Diabetes Prevention Program

The YMCA’s evidence-based Diabetes Prevention Program helps people at high risk of developing type 2 diabetes adopt and maintain healthy lifestyles by eating healthier, increasing physical activity and losing a modest amount of weight to reduce their risk of developing this disease.

In a classroom setting, a trained lifestyle coach helps small groups learn about healthier eating, physical activity and other behavior changes over 25 sessions. The year-long program consists of 16 weekly sessions and two sessions every other week during the first five months, followed by seven monthly sessions. It also includes a three-month membership to the YMCA.

A perspective on the Diabetes Prevention Program

For one Virginia Mason patient, participating in the YMCA Diabetes Prevention Program has been key to his weight loss and better overall health.

“In the past few years my weight crept up to the 230-pound range, my cholesterol kept going up and my physician told me I was prediabetic,” remembers Ray. “At my annual physical last year, I said I was planning to join the YMCA because exercise was something that had been missing in my life over the last few years. My physician told me about the YMCA’s Diabetes Prevention Program and asked if I would be interested. I said yes.”

After going to the first meeting in February 2017, Ray, who is 59 years old, decided this was something he needed to do for himself to get healthier. Since then, he has lost 15 pounds. According to Ray, other benefits of the program include the support from his lifestyle coach, consistent meetings throughout the year and the camaraderie among participants.

“Steps like keeping a daily journal, tracking my weight, trying to keep certain foods at bay and listening to other people’s stories were all very helpful and motivating,” says Ray.

Dr Brandon AuerbachBrandon Auerbach, MD, MPH, practices at Virginia Mason Hospital and Seattle Medical Center. He is board certified in internal medicine and specializes in primary care.
To learn more about the YMCA program and find a location near you, pleas visit: SeattleYMCA.org/DiabetesPreventionProgram