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When Treating Diabetes, Physicians Told to "Separate The Disease From the Person"

Posted: Monday, October 27, 2003

Diabetes control is in the hands of the patient, not in the hands of the health-care provider, family physicians were told at the Annual Scientific Assembly of the American Academy of Family Physicians. said America Bracho, MD, executive director, Latino Health Access, Santa Ana, California, United States.

The next step for physicians and health-care providers, said Dr. Bracho, is to take a hard look at their own lifestyles. She noted that this message was driven home when she worked with an HIV education program. "We had a great educator who would lecture about safe sex and the use of condoms, and then would take a break to smoke. What did that behaviour say about his own commitment to a healthy life?" In the end, she said, the HIV educator's actions undermined his message in the community.

"So when you ask about exercise or diet," she said, "ask yourself: 'Did I exercise today? What am I eating?'" Walk a mile in your patients shoes!

Even physicians who are good examples of healthy living are likely to have difficulty delivering the healthy-eating message to people with diabetes because "nutrition information is complex," she said.

To illustrate her point, Dr. Bracho explained how Latino Health Access (LHA) explains carbohydrates during its 12-week course for people with diabetes. "We tell our patients that carbs break down into sugars. Four grams of carbohydrates equals one sugar cube," she said. With that knowledge, she attacks nutritional information from labels: 1 package of tortillas has 25 grams of carbohydrates, which equals 6 sugar cubes, while 3 Oreos have 24 grams of carbohydrates -- again 6 sugar cubes. Even SnackWell's Sugar-Free Cookies, which are labeled as diet snacks, have "23 grams of carbs, 6 sugar cubes, so you can see how frustrating it can be for the person with diabetes," Dr. Bracho explained.

As difficult as the learning process can be, however, "learning how to eat is the key to freedom for people with diabetes," said Dr. Bracho.

Although physicians tend to be concerned about comorbidities such as heart disease, people with diabetes are more likely to worry about blindness, amputations, and kidney disease, said Dr. Bracho. Education programs need to address these fears.

The LHA class drives home the need for people with diabetes to take charge of eye and foot health. "We tell them that the body has little pipes and big pipes. Diabetes clogs up these pipes, but just like in a home, the little pipes get clogged before the big pipes," she said. They are told that "little pipes" are found in the eyes and in the toes, so regular eye exams are necessary to protect their eyes. And they are told to take off their shoes and ask their doctors to check their feet, she said.

Source: Diabetes In Presented October 2nd at the at the 55th Annual Scientific Assembly of the American Academy of Family Physicians. [Study title: Helping People with Diabetes Help Themselves.]

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