Proper management of blood glucose levels is vital to reduce the risk of diabetes-related complications. But it's not easy, and patients need education and support beyond what they can get in a typical office visit. "The patients are really the best allies to treat this problem — if they're well educated," says Edison Goncalves, MD, an endocrinologist with Brookwood Medical Center's Diabetes and Thyroid Associates, P.C. Goncalves sends his patients to Brookwood Medical Center's two-day diabetes education program, certified by the American Diabetes Association. And he doesn't hesitate to send them for a refresher dose if he feels their knowledge is insufficient. While nearly every Birmingham-area hospital offers diabetes education classes for patients, too few physicians take advantage of these programs, says Joette Varner, RN, CDE, and program director for the ADA-certified diabetes education outpatient program at Princeton Baptist Medical Center. "Studies have proven that education for self-management does help the patient stay in control of their diabetes," she says. Many physicians, Varner believes, do not refer patients because of the cost of the program, but she says most insurance companies provide at least some coverage. The program at Princeton starts with a one-on-one session, and is followed by a day-long group class. The program covers topics such as monitoring glucose levels, meal planning, reading labels, foot care, how different medications can affect glucose levels, coping with stress, potential complications, and the benefits of exercise. Even good printed material can help, research has found. There are many reasons patients may be lax about checking their blood glucose levels, including discomfort, inconvenience, cost, ignorance of how to interpret results and fear of "bad" results. A recent study discovered that patients who used an 18-page manual explaining how to deal with these barriers achieved much better control of their glucose. These patients were 10 times more likely than controls to increase or maintain their monitoring frequency, according to a recent report by UAB pediatric endocrinologist Elaine C. Moreland, MD, in the Archives of Internal Medicine. The booklet gives practical advice on how to deal with the emotional ups and downs that diabetics confront. Another important factor in controlling blood glucose is exercise. The Fitness Center at Medical Center East goes beyond just educating patients about the importance of exercise. It offers an eight-week program designed to help diabetic or prediabetic patients develop good exercise habits. After an initial assessment, patients work one on one with an instructor and check their blood glucose before and after exercise. After eight weeks, the center can demonstrate to patients how exercise affects their blood glucose. Progress reports can be sent to the referring physician. "I think physicians understand the importance of exercise, but [typically] they really has no control of any follow-through," says Bill Huber, administrative director of rehab. "There's no accountability of how much they're doing or what they're doing." At the Medical Center East facility, patients must put a key in the exercise equipment, which will identify the patient and keep track of the exercise done. Then the information is captured by computer. "We can print out every session you've done in eight weeks and [show] how much you really have done when you go back to your doctor." November 2006