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REVIEW Diabetes is a chronic, complex, and destructive disease that can cause
a wide range of problems including kidney failure, heart disease, amputations,
destructive periodontitis, and blindness. Approximately 16 million Americans
have diabetes. Classified as a "chronic disease epidemic" by the Centers
for Disease Control and Prevention, the prevalence of diabetes has increased
dramatically over the past forty years. This trend is especially significant
among minority populations.
An interdisciplinary, team approach to diabetes management is essential.
A recent American Public Health Association statement recommended comprehensive
(interdisciplinary) care for all persons with diabetes, including high-risk
populations of African-Americans, Hispanic-Americans, and Native Americans.
Ft. Lauderdale, FL, was the site of the Second Annual Symposium on Diabetes:
"A Comprehensive Update for the Primary Health Care Provider". The conference
took place on Saturday, March 8, 2003 at The Health Professions Division
of Nova Southeastern University (NSU). The goal of this symposium was to
provide an interdisciplinary educational program that offers practical
knowledge about diabetes to primary health care providers. It was designed
to bring together primary care physicians and other health professionals
who care for the patient with diabetes and manage complications of this
disease. A multi-disciplinary faculty of acknowledged leaders in the field
presented current and future concepts in clinical management, within a
team-oriented model of primary health care.
Highlights of the symposium included Perspectives in Diabetes, a Keynote
Session that featured noted author and expert on chronic disease management
Catherine
Feste, who drew upon her own experience of living well with diabetes.
Ms. Feste presented several case studies in patient empowerment, and proposed
a new chronic disease model in which patients are given the opportunity
to explore healthy coping strategies. Today’s patient with diabetes is
no longer a passive member of the health care team, but a primary decision-maker
who draws upon the expertise of medical professionals.
The second keynote speaker was
Alan Morrison, an osteopathic
physician and internist who serves on The Diabetes Advisory Council for
the State of Florida. Dr. Morrison presented a lecture entitled: Current
Concepts in Diabetes Mellitus, in which he covered epidemiology, pathogenesis,
risk factors, diagnostic criteria, and general manifestations of the disease.
These opening lectures effectively set the stage for the General Sessions,
the first of which highlighted Diabetes in Youth. Pediatric endocrinologist
Marco
Danon presented timely information on Type 1 Juvenile Diabetes. Dr.
Danon also teamed with pediatrician Edward Packer to discuss management
of diabetes in children, using clinical guidelines and case examples. Dr.
Packer went on to discuss The Importance of Recognizing Type 2 in Adolescents.
The topical focus on pediatric issues continued with a discussion of Non-invasive
Visual Assessment Instruments in Infants and People Living with Diabetes,
by Eugenie Hartmann, who heads The NSU Eye Institute’s Visual Electrodiagnostics
Service and conducts research in this area.
The second General Session reviewed common Complications of Diabetes.
Optometric physician Alan Kabat discussed Ocular Manifestations
of. This was followed by a review of Low Vision Rehabilitation for Patients
with Diabetic Retinopathy, in which Dawn K. DeCarlo (a low vision
optometric physician) and Elysa Lipschutz (an occupational therapist)
explained the roles of rehabilitative optometry and occupational therapy
in the management plan. Periodontist and researcher
Irene Marron,
reviewed Oral Health Issues in Diabetes, and she was followed by podiatrist
Steven Spinner, who discussed Preventive Strategies for the Diabetic
Foot.
Like the preceding General Session I and Keynote Session, the Focus
on Complications included an interactive component in which a moderator
asked the panel of speakers a series of questions submitted by the audience.
This is where some of the most valuable, case-based discussions took place.
In addition, a dynamic exchange of ideas ensued, as the various symposium
attendees from the fields of medicine (both allopathic and osteopathic),
dentistry, optometry, pharmacy, and allied health got together in the atrium
during breaks and a casual luncheon. Equally impressive was that the symposium
offered eight hours of Continuing Medical Education credit to each of these
provider groups.
The symposium’s Closing Session outlined A Global Approach to Diabetes
Management. This session was led by a timely review of current Clinical
Management Guidelines, in which family physician
Joseph DeGaetano
recommended an interdisciplinary, evidence-based model of care. Registered
dietician and wellness expert Alix B. Landman presented current
nutritional guidelines, as well as information on Diets, Herbs, and Supplements.
Clinical pharmacist and diabetes patient educator Karen Daniel presented
advances in Pharmacology, Insulin Delivery Systems and New Glucose Monitoring
Devices. Closing out the program was an energetic discussion of The Role
of Exercise and Physical Therapy in Diabetic Management by physical therapist
Debra
Stern.
This unique, multidisciplinary continuing medical education program
met its primary goal of bringing together different types of health care
professionals, presenting the most current, evidence-based practice guidelines,
and fostering a team model of care for the diabetes patient.
References
- Robbins, J. and Holland, P., Passage of Policy
Statement on the High Risk of Blindness, Lower-Extremity Amputations, and
Oral Health Consequences in Minority Populations Due to Diabetes, J. Am.
Podiatric Med. Assn., Vol. 91, Number 6, June 2001
- Mainos, AG and Talbert, J., Assessing Quality
of Care via HEDIS 3.0, Archives of Family Medicine, 7(5):410-3, 1998 Sep-Oct
- Burke, James P., Rapid rise in the Incidence of
Type 2 Diabetes From 1987 to 1996: Results From the San Antonio Heart Study,
Arch. Intern. Med. 199; 159: 1450-1456.
- American Diabetes Association: Diabetes 1996;
Vital Statistics, Alexandria, VA, 1996.
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