Making An Impact In Diabetes Treatment

By Jeff Hall

It seems like every other day, there is a new study pointing to alarming statistics about the increasing prevalance of diabetes. Approximately 16 million Americans have diabetes, but many believe the figure may be even higher. It could get a lot worse. According to estimates from the Centers for Disease Control and Prevention, 47 million people in the U.S. are at risk for type II diabetes. Raising awareness of the disease and its potential complications continues to be a problem. Just as this issue went to press, results of a joint survey by the American Diabetes Association (ADA) and the American College of Cardiology were released. According to the survey, two out of three people with diabetes are not aware of their increased risk for heart disease and stroke. This is particularly disturbing as 65 percent of Americans with diabetes die from heart attacks or strokes, according to the ADA. On the other hand, we know changes in diet and exercise can go a long way toward preventing the onset of type II diabetes. This has been reinforced by results from a multi-center study by the National Institutes Of Health. As reported in the New England Journal Of Medicine, the study of over 3,000 non-diabetics at high-risk found that lifestyle modification and a twice-a-day dose of metformin helped to delay the onset of diabetes. Lifestyle modification (aka diet and exercise) proved to be twice as effective. (It should also be noted that the FDA has recently granted approval to several pharmaceutical companies to begin marketing generic versions of Bristol-Meyers Squibb’s Glucophage (metformin)). In the midst of these developments, we bring you our Second Annual Diabetes Treatment theme issue. I’m proud to say it is one of our strongest issues to date. For the cover story (see page 28), Ken Rehm, DPM, addresses the problematic combination of diabetes and depression. He emphasizes how important it is for podiatrists to recognize the problem and understand how diabetes can have such a serious psychological impact. As Dr. Rehm suggests, not only can DPMs make empowering recommendations and appropriate referrals, but they can also learn from the successes of diabetes educators and apply the lessons in their office. I’m also very proud to announce the first installment of our continuing education series (see page 50). In “A Review of Ethnic Differences In Risk Factors for Diabetic Foot Ulcers,” Caroline Abbott, PhD, and Carine van Schie, PhD, offer a thorough review of the literature and their own studies as well to provide diagnostic insights and raise awareness. We also have features on the wound healing modalities Dermagraft and Apligraf. In “How To Treat Diabetic Ulcers with Dermagraft” (see page 32), the authors offer key instructional pointers on how to optimize treatment results with the modality that recently received FDA approval. There is also a very informative discussion on Apligraf in this month’s Wound Care Q&A column (see page 63). Other intriguing articles include “Alternative, Complementary Therapies For Diabetes,” penned by John Hahn, DPM, ND. In his article (see page 40), Dr. Hahn urges to consider such treatments as Alpha Lipoic Acid and chelation therapy. In the “Diabetes Watch” column (see page 14), Eric Feit, DPM, and Alona Kashanian, DPM, offer advice on prescribing custom orthoses for those with diabetes. Given that podiatrists are often on the frontlines of treating this disease, I believe you’ll find these articles thought-provoking, informative and hopefully very helpful in your ongoing quest to achieve successful treatment results for your patients with diabetes.

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