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Care Providers Must Actively Engage Diabetes Patients in the Decision-Making Process Regarding Treatment

Diabetes Mellitus is derived from the Greek word diabanein, which literally means “passing through” or “siphon”.  This term refers to one of the main symptoms of Diabetes—excessive urination.  Diabetes is also known as hyperglycemia, which is the state of too much glucose (sugar) in the blood.  Hyperglycemia occurs when the body is unable to regulate the level of glucose in the blood, resulting in too much glucose.  This excess of glucose in the blood is processed by the liver where it is converted into a form (glycogen) to be stored for future use.  Blood glucose level is regulated by insulin, a hormone made in the islet cells in the pancreas.  Insulin acts as a key, enabling the body’s cells to absorb and use glucose.   When insulin levels are insufficient, glucose from the blood is unable to enter the body’s cells, thereby preventing it from being used as fuel to support its continued function.

Glucose is the main sugar that is produced from the digestion of foods and liquids.  Carbohydrates, in the form of sugars, and starches are broken down to glucose in the digestive system and absorbed into the blood stream.  Examples of sources of glucose are breads, cereals, dairy goods (such as milk), fruits, and some vegetables (such as potatoes and corn).  Glucose is the simplest form of sugar, vital for providing energy for cells to function and grow.  Glucose travels through the blood stream to all organs and muscles of the body, where it is used as a fuel.

About 16 million Americans are estimated to have diabetes, with over 50% of individuals over the age of 60.  Within the population of those ages 65 and older, almost 1 in 5 has diabetes mellitus and most are type 2.  About 1.7 million new cases of diabetes in people aged 20 years or older are diagnosed each year.  This disease is the 6th leading cause of death in the United States.  It is a costly disease; in 2012, $245 billion in healthcare expenses were spent due to diabetes.

Groups who are at increased risk of type 2 diabetes are Hispanics, African Americans, and Pima Indians. Other risk factors include being over 40 years of age, obesity, physical inactivity, family history with diabetes, hypertension, hyperlipidemia, and a history of gestenational diabetes (developing diabetes during pregnancy).

Common symptoms that characterize diabetes are:

  • A loss of elasticity and flexibility of skin and other tissues
  • Skin ailments such as infections, discolored spots, thin skin, and rashes
  • Cardiovascular disorders such as poor circulation, atherosclerosis, blood blots, strokes, and heart attacks
  • Increased prevalence of cancer
  • Eye disorders such as cataracts, glaucoma, and retinal degeneration
  • Hearing loss
  • Cognitive impairments, memory loss, and dementia
  • Impotence

It is well known that the older adult population is heterogeneous, and this includes the elderly diabetes population.  Therefore, care providers should encourage their patients to participate in shared decision making with respect to their preferred treatment options, ability to take care of themselves, and treatment goals, and consider their patients’ likelihood of risk and benefit from intensive treatments.