Tuesday, February 26, 2013


I apologize for lack of almost daily posting. I have been busy for the last few months . Things should slow down for me soon.  In the mean time I will repeat some of my slightly used older post and comments.
Dr. Calder

WEDNESDAY, FEBRUARY 22, 2012


Fixing The 9 ,prevents heart disease and amputation

I was reading Internal Medicine News this morning and one article got my attention.

 Amputations decline 65% in Diabetic patients 
      by Diana Mahoney
    The major finding was , the rate of hospitalizations for non traumatic amputations has decreased from 11.2/1000 persons in 1996 to 3.9/1000 persons in 2008. This informations was collected and reported by the Centers  For Disease Control (CDC )

This is good news and probable means that we are all doing a better job with preventive  health care.

The bad news was reported in Diabetes Care 2012;35: 273-7. They reported that even with the significant decline in amputations , the amputation rate is still eight times higher than in the non-Diabetic population.
(3.9 vs 0.5 persons per 1000)

comment ;
      When was your last Diabetes Foot Exam ?

      Do you know what a Diabetes Foot Exam is ?  It is more then a quick look at your foot

 This  subject brings up something that has bothered me for years about our approach to diabetes care. 

Diabetes  risk management by default is primarily physician and institution based .
I helped develop a  computer assisted Diabetes Wellness Assessment Program  (DWAP) for my medical group with a goal of reducing the risk of heart disease and other diabetes complications. This was very successful in improving diabetes risk factor management . However, even with the  great effort and expense by the doctors , nurses , diabetes educators and administration , we were not 100% successful .
We had the most success in test and exams that were set up to be done automatically such as lab. test and we had the least success with test and exams requiring input and recall by patients, physicians and staff with things like foot exams and achieving some of the goals.

I have felt for a long time that one essential ingredient in our plan was overlooked. 

We neglected to adequately empower each patient with the responsibility for their own care and
we also made risk management to complicated.

 Finding a way to Simplify diabetes care and Empower Patients to be more involved in their own care was the reason for me writing  , Diabetes Office visit 

The basic principle of the book and iPhone , iPad app is to empower patients to set target goals for their test and exams, then reach those goals with the help of their doctor and prevent the complications of diabetes.

 I manage to hide these basic concepts with to much verbiage, discussing back ground and studies supporting the reasons for the test. 

 My son in law, Vince,  and Herman Cain  helped me simplify and make my idea more useful. 

Herman Cain promoted the idea of his 9-9-9 plan for simplifying our tax code.

My son in law helped me realize that reaching diabetes treatment goals is simply a game of numbers and that understanding the numbers is not necessary for fixing them.

 The understanding and meaning of those numbers will come with time and repetition .

So I have now shortened my book  concept to Fixing the 9 for people with Diabetes and Fixing the 6 for non -diabetics with a primary goal of reducing the number one killer for all of us , Heart Disease

Fixing those 9 risk factor will have a little side benefit of reducing the risk of eye and foot problems

please go to the Diabetes office Visit Training Video  tab above for more information on goals setting and risk management ideas . I developed the video for Iphone and iPad users but it help you understand the ideas behind goal setting and risk management .

Have fun , Be Smart  and Defeat Diabetes,
David Calder,MD

3 comments:

  1. We had the most success in test and exams that were set up to be done automatically such as lab. test and we had the least success with test and exams requiring input and recall by patients, physicians and staff with things like foot exams and achieving some of the goals.

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    Replies

    1. We had the same experience with a Diabetes Wellness Assessment Program (DWAP )  in Peace Health Medical group.. .
      Dr. Calder

1 comment:

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Your comments and questions are appreciated. David Calder,MD