CDC: Diabetes Prevalence Up 14 Percent In Two Years

By Brian McCurdy, Associate Editor

   The prevalence of diabetes in the United States has increased by 14 percent in the last two years, according to a recent report by the Centers for Disease Control and Prevention (CDC). The report concludes that 20.8 million people in the U.S., 7 percent of the population, have the disease and 6.2 million of these people are undiagnosed. In 2003, an estimated 18.2 million people had diabetes, according to the CDC.    Why the rapid rise in diabetes prevalence in just two years? The overall incidence of diabetes may be increasing due to declining diets and sedentary lifestyles, notes Ken Rehm, DPM, a Diplomate of the American Board of Multiple Specialties in Podiatry. However, Dr. Rehm says the recent spike may also be due to increased media coverage of diabetes, which has made both patients and doctors more aware of the disease.     “Patients come in to me asking how they can be tested for diabetes. They never used to do this,” comments Dr. Rehm, who is board-certified in treating and preventing diabetic foot wounds.

Emphasizing Preventive Measures

   That said, what should DPMs and patients be doing to prevent a further rise in diabetes prevalence? Dr. Rehm says podiatrists must learn to treat not just foot problems but people who have foot problems. Accordingly, he emphasizes having an increased awareness of how diabetic complications such as neuropathy, peripheral arterial disease and high blood sugars are interrelated, and how they can lead to increased risks for lower extremity complications and potential amputations.    In addition to having a thorough understanding of how various medical conditions can lead to lower extremity dilemmas, Dr. Rehm says DPMs must take an active role in educating patients and facilitating an appropriate preventive program.    Encouraging patients to walk is a vital part of such a preventive lifestyle, says David G. Armstrong, DPM, PhD, a Professor of Surgery, Chair of Research and Assistant Dean at Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. He notes that walking 150 minutes a week can reduce the risk of diabetes by about two-thirds.    To determine if a patient has pre-diabetes, Dr. Rehm says one must conduct the appropriate blood testing of blood sugars and HbA1c. If such tests are abnormal, he suggests referring the patient back to the primary care physician or endocrinologist.    Encouraging patients to take an active role in managing their condition is another important point of emphasis. Dr. Armstrong, an immediate past member of the National Board of Directors of the American Diabetes Association, says his group, the Center for Lower Extremity Ambulatory Research, is currently studying “diabetes cell phones.” The phones include glucose meters and pedometers. He says a trial is planned in which patients would pay less for their cell phones the more often they check their glucose or walk.     “We must put our money where our mouth is if we are going to make any substantive difference,” implores Dr. Armstrong. “It is innovative ideas like this, coupled with a bit of common sense, that can really turn back this overwhelming hyperglycemic tide.”

DPM Brings Podiatric Expertise To Iraq

By Brian McCurdy, Associate Editor    While Patrick DeHeer, DPM, has previously traveled to Honduras and Haiti on mission trips to treat podiatric problems, his latest trip took him to the Iraq city of Erbil.    Dr. DeHeer returned in October from the weeks long trip organized by the Baptist Medical and Dental Fellowship of Gainesville, Fla. Although he did not have an opportunity to perform surgery, Dr. DeHeer did lecture to Iraqi orthopedic surgeons regarding care of a variety of podiatric conditions. Topics included specialized treatments such as using the Ponsetti method for clubfoot.    Diabetes-related problems such as amputations are also prevalent in Iraq. Accordingly, Dr. DeHeer, a Fellow of the American College of Foot and Ankle Surgeons, spoke with the doctors on levels and techniques of amputation as well as general diabetic foot care. He also shared insights on Achilles tendon lengthening and treating non-healing wounds.     “They have been cut off from the West for so long that their specialized surgery has gotten poor. Basically, they are trauma surgeons,” says Dr. DeHeer of the Iraqi doctors.    Dr. DeHeer recalls flying into Baghdad and having travel problems with his visa. While he notes that Baghdad was dangerous, Dr. DeHeer says he felt safe speaking in Erbil, which is in the Kurdistan region in northeastern Iraq. However, he says surgeons in Erbil have been isolated due to Saddam Hussein’s former regime and could not access equipment such as cannulated screws. Dr. DeHeer brought the Iraqi doctors the external fixation materials that they could not obtain.    He says the Erbil podiatrists are very “appreciative of what the U.S. has done for them.”    Dr. DeHeer notes that he met with Kurdistan’s Minister of Health and the two plan to help facilitate a reciprocal podiatric educational relationship between the two nations.

Multidisciplinary Group To Tackle MRSA Prevention

By Brian McCurdy, Associate Editor    Infections due to methicillin resistant Staphylococcus aureus (MRSA) are becoming increasingly common in healthcare settings and the community. The recently formed MRSA Leadership Initiative is responding to the increased infection prevalence by utilizing the knowledge of specialists in a wide range of fields.    The project, sponsored by Pfizer, will concentrate on research and awareness programs in preventing infection among high-risk patients. Over the past 30 years, MRSA prevalence among S. aureus infections has increased from 2 to 60 percent, according to the MRSA Leadership Initiative. In addition, the initiative notes 8 to 20 percent of MRSA patient samples studied by the CDC were community-acquired strains.    As organisms evolve, resistance is more prevalent in the community so practitioners cannot maintain the same guidelines for empiric treatment, notes MRSA Leadership Initiative member John E. McGowan Jr., MD.     “In some parts of the country, we now have to rethink the way we handle patients because some of these community-acquired infections may be due to MRSA,” he says.    To treat community-acquired MRSA, doctors should be thorough with the patient history and determine where patients acquired the infection, emphasizes Dr. McGowan, a Professor in the Department of Epidemiology at the Rollins School of Public Health at Emory University in Atlanta. One must also consider the patient’s family as patients may pass MRSA infections to family members. He also advises practitioners to use aseptic precautions such as regularly washing hands and covering open skin area infections.     “Early identification of an MRSA infection is key to ensuring a patient’s successful treatment and reducing the risk of long-term complications of the infection,” notes Dr. McGowan. “The fact that these infections are increasingly contracted in the communities where we live and play, in addition to the hospital settings, means we must become more focused and vigilant in our efforts to prevent, properly diagnose and treat them.”

In Brief

   The American Podiatric Medical Association (APMA) recognized four individuals and two organizations as recipients of the annual Board of Trustees Awards.    The APMA awarded the Distinguished Service Citation to Richard H. Lanham Jr., DPM, Marc D. Lenet, DPM, and Jeffrey M. Robbins, DPM. The award is given to those who have contributed to the field of podiatry on a national level, according to the APMA.    Wayne Probasco, JD, received the Meritorious Service Award for Non-Podiatrists. The American Academy of Podiatric Sports Medicine and the International Federation of Podiatry each received the APMA’s Humanitarian Award.

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