When Treating Diabetes, Physicians
Told to "Separate The Disease From the
Person"
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.
Physicians need to re-think the way they address
diabetes, beginning with the terminology they
use, said America Bracho, MD, executive director,
Latino Health Access, Santa Ana, California,
United States.
"We need to separate the person from the
disease," she said, noting that rather
than using terms like "diabetics"
or "patients with diabetes," health-care
providers should say "people with diabetes"
or "people affected by diabetes."
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.
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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