Cross Trails Medical Center giving special care to diabetics

MARBLE HILL, Mo. -- On Tuesday mornings at Cross Trails Medical Center, the staff knows exactly which patients they'll be seeing even before they look at a chart.

Nearly every patient scheduled for appointments on Tuesdays is diabetic, though the disease might not be the primary reason for their visit.

When Ruth Pinnell, 61, of Glenallen, Mo., came for her checkup, she visited with diabetic educator Ashley Lipke to talk about how Pinnell's maintaining her blood sugar level, adjusting to medication and progressing on her goal to lose weight.

Pinnell has been diabetic for more than 15 years and is still battling to control her disease.

She's seen a spike recently in her blood sugar readings and wants to lower that number. She's put on some weight she'd rather have lost and needs help adjusting her diet so she can lose even more without jeopardizing her health.

Pinnell was diagnosed with diabetes in her late 40s. Since then she's tried to learn as much as she can about the disease and has made an effort to get herself under better control.

"I just don't want to die at an early age," she said.

Cross Trails is trying to make sure every patient it sees gets the proper care and testing necessary to control the disease.

For the past 13 months, the Marble Hill clinic has been enrolling its diabetic patients in a collaborative project sponsored by the U.S. Bureau of Primary Health Care, a division of the U.S. Department of Health and Human Services.

Cross Trails plans its "Diabetic Tuesdays" in Marble Hill so that every patient has a chance to get lab tests or blood drawn, see the nurse practitioner, doctor, dentist and diabetes educator without coming back for separate appointments.

A similar program began last week in Advance, where it is "Diabetic Wednesdays" for the clinic. The Cape Girardeau Cross Trails location likely will begin its diabetes program in January.

Cross Trails specializes in offering health-care services to low-income patients and people who receive Medicare and Medicaid. Payments are based on a sliding scale, and a grant program allows the diabetic patients to receive some necessary medication regardless of their ability to pay.

Diabetes is a chronic disease but not necessarily a fatal one. It affects 18.2 million people in the United States whose bodies cannot properly produce or use insulin, a hormone that converts sugar, starches and other foods into energy used by the body.

There were several initiatives to select from when Cross Trails was examining programs to participate in, but the clinic wanted to focus on diabetes first because it had the staff in place and a population with the disease.

The next initiative might focus on cardiovascular health, said Chrissy Warren, Cross Trails' chief operating officer. Other initiatives focus on depression and cancer, and there's a possible program that would combat obesity.

213 patients

The program's overall goal is to help people with chronic diseases get better.

Since the diabetes collaborative effort began, 213 patients at the Marble Hill site have been enrolled in the program. Nearly 98 percent of them have Type 2 diabetes, which is the most common form of diabetes. Most of the patients are women, with about 35 percent men.

Every two weeks the diabetes team -- doctors, nurse practitioner, nurses, educators and administrators -- meets over lunch in the clinic's break room to talk about their efforts. A statistical report shows the breakdown of patient percentages with particular problems and trends that need to be addressed.

Because of the push for patient-centered care and the constant reminders the reports bring, the diabetes project at Marble Hill has surpassed national reporting standards, Warren said.

More than 59 percent of the clinic's diabetic patients get regular oral hygiene checkups because a dentist is on site, while nationally the number is only 23 percent.

"Doing this improves their care," Lipke said of the patients. "We're seeing improvements."

There are a lot of variables in how a person accepts and manages diabetes care, said Susan Farrow, a nurse practitioner at the clinic who specializes in foot care.

"Their perception of the disease and how it affects their life and whether or not they want to manage it" are all factors, she said. "Some people need a trauma to give them a wake-up call."

Not just diet

Lifestyle modifications are the key in learning to manage diabetes, Lipke said, and that's the hardest part of the disease. Those modifications can involve more than just diet. They involve exercise, understanding how what you eat can affect medication and insulin, and recognizing what low blood sugar feels like. There's also a reminder to patients never to go barefoot and to constantly check their feet for sores because diabetics can be prone to infections.

At each visit, Lipke usually reviews patients' goals and reminds them of goals they'd set previously.

For Pinnell, a visit on "Diabetic Tuesday" gives her a chance to ask questions about her disease and to learn more about ways to take care of herself.

During a conversation with Lipke, Pinnell rattles off some more information about what she's eaten in the last few days and how her blood sugar has responded with the introduction of a generic Glucophage drug. Her body has been resistant to insulin injections up to now, but with the combination of a 24-hour dose of Lantis, a longer-lasting kind of insulin, and the Glucophage she's managing fairly well.

"I'm a challenging patient," she says as a joke to Lipke.

Before leaving the office, Pinnell receives a new glucometer to use for testing her blood sugar. Her old machine isn't tearing through the packaging on the strips like it should, and that can affect how well the machine registers her blood sugar readings.

Farrow, the nurse practitioner, said one of the most important goals a person can set is to lose 10 percent of their body weight. Losing the weight helps give the patient better control over blood sugar and helps maintain better overall health. She'd also like every patient to begin walking for 30 minutes four to five days a week and take their medications faithfully.

"Part of the program is to empower the patient because they are the ones who manage the disease," she said.

The collaborative project gives them the tools and resource to do that, Lipke said.

To register for the diabetes collaborative program, call the clinic at (573) 238-2725.

ljohnston@semissourian.com

335-6611, extension 126