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Diabetic Heart and Vascular Disease Program
One of the most exciting developments in medical treatment is the finding that the onset of diabetes in adults can be significantly delayed, and many complications entirely prevented, by simply modifying risk factors like obesity, high blood pressure and smoking, and incorporating a good diet and regular exercise. Patients already afflicted with diabetes are at significantly increased risk of heart and vascular disease, and should be proactively screened and followed for these diseases and their associated complications.
To help patients accomplish these goals, Deborah Heart and Lung Center recently established its Diabetic Heart and Vascular Disease Program, which provides comprehensive preventive and treatment services to patients with, or at risk of, diabetes. Included in the program is a dedicated, multidisciplinary team of internists, cardiologists, vascular medicine and vascular surgery specialists, physician assistants, pharmacists, nutritionists, and case managers, as well as a coordinated network of community physicians, providing services such as diabetic foot and eye care. This team collaborates to provide thorough evaluations, in-depth patient education, individualized risk-management programs, and cutting-edge interventional and surgical procedures.
“Recent medical developments have shown that, with aggressive efforts to reduce or eliminate risk factors, many complications from diabetes can be prevented, and the onset of the disease itself can be delayed,” explained Augustine Agocha, MD, PhD, Interim Director of the Diabetic Heart and Vascular Disease Program and Medical Director of Outpatient Services. “If we can help manage risk factors prior to, or early in, the disease process, we will help these patients slow the progression of the disease, and avoid unnecessary complications, medical treatment, or procedures."
To support these efforts, and to more effectively measure treatment success, when entering the program, each patient receives a comprehensive initial health status screen to collect baseline health information, as well as a personalized care plan for treatment, diet and exercise programs. Extensive patient education from specialists in the program is provided to ensure understanding of treatment plans, including consultation with registered dietitians, and a self-care and health goal setting educational program.
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Cardiac and Vascular Care
One of the foremost goals of the Diabetic Heart and Vascular Disease Program is to provide a complete cardiac and vascular assessment to every patient with a diagnosis of diabetes. According to a recent consensus statement issued by the American Diabetes Association, diabetes is the most powerful risk factor for peripheral arterial disease (PAD); if tested with an ankle-brachial index, as many as a third of diabetes patients can be expected to have PAD.
“Peripheral arterial disease is particularly dangerous in diabetic patients, as the typical symptom of claudication often doesn’t occur in patients with coexisting diabetes,” stated Manu Rajachandran, MD, Chair, Department of Endovascular Medicine. “Many patients won’t feel symptoms until so late in the vascular disease progression that limb-threatening ischemia has already developed. Thus, physicians must be proactive in screening diabetes patients for peripheral arterial disease, so that intervention can occur before the disease progresses. Deborah’s emphasis on total vascular care of the diabetic patient will help accomplish this.”
Information Technology
In addition to a multidisciplinary team of dedicated specialists, Deborah Heart and Lung Center’s Diabetic Heart and Vascular Disease Program follows patients using the Diabetic Cardiovascular Patient Registry, a customized, advanced clinical information system which personalizes every patient’s treatment, education and support system needs. Deborah is already one of the most wired hospitals in the region with an advanced electronic medical record system and computerized provider order entry. The registry database takes this a step further and tracks each patient, storing all test results and providing reminders to providers when future tests are due. The registry also facilitates medical research and allows the care team to periodically review statistics on treatments, goal attainment, and effectiveness in prevention of complications.
Community Network
For aspects of diabetic care that are not provided at Deborah Heart and Lung Center, such as diabetic foot and eye care, a Community Connection Network of preferred providers has been complied by Deborah’s diabetes program to help patients find the best specialists in their area. These providers will see diabetic patients in their own offices, but will work together with Deborah’s diabetes specialists to provide collaborative care for end-organ complications of the disease. The key is communication and seamless transfer of health information from one provider to the next. Patients will be referred on a case-by-case basis, to the provider best able to treat the individual patient, and who is geographically most convenient to the patient’s residence.
Collaborative, Personalized Care
"Realizing that not every patient is best served by any one approach, Deborah has created a comprehensive program that would offer its patients any possible combination of heart and vascular disease treatment," said Dr. Agocha. "The collaborative and comprehensive nature of this program and its associated disciplines allows us to make informed decisions about how to best care for each or our patients."
Program Components:
• Multidisciplinary team of physicians, specialized nurses, physician assistants,
nutritionists, educators and pharmacists
• Advanced clinical information system, which includes a customized Diabetic Cardiovascular Patient Registry and Follow-up System that personalizes every patient’s treatment, education and support system needs
• Comprehensive initial health status screen to collect baseline health information
• Personalized care plan for treatment, diet, exercise and educational programs
• Community Connection Network of preferred providers of diabetic foot and eye care
• Self-care and health goal setting educational program
• Clinical research program
• Community-based educational programs on diabetes care, healthy diet, exercise and fitness, and stress-free living
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