VOL. 129 | NO. 64 | Wednesday, April 02, 2014
By Don Wade
Greg Smith was a hard worker. Ran a carpet cleaning crew, didn’t mind putting in 10 or 12 hours a day to get the job done.
Gregory Smith reviews his blood sugar logs with Healthy Memphis Common Table patient coach Betsy Friedman. The organization’s Project Better Care Report is part of its work with Aligning Forces for Quality.
(Daily News/Andrew J. Breig)
He ate what he could – honey buns were a favorite – when he could. He wasn’t a big soda guy, instead drinking orange juice day and night.
“All that did was elevate my blood sugar,” Smith said.
“Diabetes sneaks up on people,” said Dr. Susan Nelson, medical director for Healthy Memphis Common Table’s Project Better Care. “You can have it for a couple of years and not know it. And it’s already damaging your eyes and kidneys.”
Smith, 58, has been part of PBC for about a year, working with a “patient coach” to help him manage his Type 2 diabetes.
When he started in the program, his hemoglobin A1C number was, as Smith put it, “off the chart.” The normal range for an A1C level is between 4 percent and 5.6 percent. If 5.7 to 6.4 percent, a person is considered to be at a higher risk for diabetes. And if 6.5 percent or higher, diabetes is indicated. But the chart only goes up to 12, which correlates to a mean blood sugar of 345. His was higher than that.
And it was at this point that Smith met his patient coach, Betsy Friedman, from Healthy Memphis Common Table. Another title for Friedman and her colleagues might be change agent, but Friedman says the plan for improving the patient’s condition has much to with the patient’s willingness to embrace some lifestyle changes – even if that means starting slowly and taking one step back for every two steps forward.
“At first, I was pushing against it,” Smith said. “But she came in with a smiling face and a positive attitude and worked on me. She reinforced all the positive stuff I had in my life. She asked me a lot of questions, found out what my needs were.”
Said Friedman: “My task is to find out what’s important to the patient, first and foremost.”
Over 20 months, Healthy Memphis Common Table has documented improvements in diabetes patients due to Project Better Care, including lower A1C scores, better results in foot exams and greater knowledge on the part of patients as they take a more active role in managing their diabetes.
The Project Better Care Report is part of HMCT’s work with Aligning Forces for Quality, or AF4Q, the Robert Wood Johnson Foundation’s effort to improve the overall quality of health care throughout the United States. HMCT is one of 16 communities in the country participating in AF4Q.
Diabetes affects 25.8 million people in the United States, or about 8.3 percent of the population, according to the Centers for Disease Control and Prevention. Of that number, 18.8 million people have been diagnosed and 7 million are undiagnosed.
Based on fasting glucose or hemoglobin A1C levels, 35 percent of U.S. adults 20 or older have pre-diabetes.
“You can walk around a long time and have no idea your blood sugar is 250,” Nelson said.
Thus, for most people, Nelson said, the diagnosis of diabetes is startling news. This is why Friedman tries to not push too hard initially.
“As soon as they have a sense of hope that they can (make changes), they take off,” Friedman said.
“I had days I didn’t want to do anything,” Smith said. “I just wanted to stay in bed. I had to get my body chemistry back so I could go to the next step.”
Smith is making progress, with his A1C score around 7. But he still has some pain in his legs and back, and he suffered nerve damage.
“The damage is done; I can’t change what I did,” Smith said. “But I can change the future. I don’t want them cutting off body parts.”
Both Nelson and Friedman are encouraged by the progress they’ve seen people make. And Friedman says managing medication can be difficult for anyone and takes commitment.
“I’m not even a person who takes my medicine as directed,” she said. “I’m just as human as they are.”
Of course, the earlier the diagnosis comes and the earlier changes in diet and lifestyle follow, the better.
“If I can get them to exercise, get off the couch for 30 minutes, you can cure this illness – meaning, they can get their A1C down below five,” Nelson said. “You can basically make diabetes go away. From a provider standpoint, I’d love to assign everybody to a patient coach.”