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Published on November 14, 2014

Stephen Brietzke, MD

Stephen Brietzke, MD, chats with longtime patient Daniel Haintel, of Fulton, at the University Physicians-Woodrail Internal Medicine and Pediatrics clinic. Haintel was diagnosed with Type I diabetes in his late teens. An endocrinologist, Brietzke is a professor of medicine at the University of Missouri School of Medicine and associate chief medical officer for University of Missouri Health Care.

Diabetes Care Programs Help Patients Cope With Diagnoses and Treatment

November is National Diabetes Awareness Month, and the World Health Organization has designated Friday, Nov. 14, as National Diabetes Day.

As part of this month’s focus on diabetes, specialists at University of Missouri Health Care will be holding a series of educational workshops for adults and children with diabetes and their family members or caregivers from 8:30 a.m. to 11:30 a.m. on Saturday, Nov. 15, at Women’s and Children’s Hospital, 404 Keene St. Workshop topics include “Carbs of Our Lives,” “How the Grinch Planned Holiday Meals,” “As Technology Turns,” “The Weakest Attitude” and “Exercising with the Stars.” Registration is $7 in advance or $5 at the door. To register or for more information, please contact the Endocrinology and Diabetes Center at University Hospital at 573-882-3818.

More than 29 million people living in the United States have the disease, which causes high levels of glucose in the blood and defects in insulin action or amount of insulin produced. According to the Centers for Disease Control and Prevention, nearly 28 percent of those with diabetes are not diagnosed and not being treated for the condition. The seventh leading cause of death in the U.S., diabetes is associated with serious health complications, such as heart disease and stroke, kidney failure, blindness and limb amputation.

The disease is classified into three types: type 1, type 2 and Monogenic Diabetes of Youth. The exact cause of type 1 is unknown but genetics and exposure to certain environmental factors and viruses may play a role.
“Type 1 diabetes patients with proper care can lead a long healthy life,” said Bert Bachrach, M.D., director of the Division of Pediatric Diabetes and Endocrinology and associate professor of clinical child health in the MU School of Medicine.  “A patient with diabetes can prevent complications with excellent control and taking responsibility for his own care, which includes applying technology, insulin and meal planning.”

There is no way to prevent type 1 diabetes, but early detection is important to recognize patients at risk, according to Bachrach.

It is one of the most common diseases in school-aged children; those between the ages 5 and 9 years old account for most of the new cases. Approximately 208,000 people in the 5-9 age group have been diagnosed with type 1 or type 2 diabetes. That number continues to increase each year, according to the CDC. It’s estimated more than 18,000 youths and children in the United States will be newly diagnosed with type 1 diabetes and another 5,000 of the same age group will be diagnosed with type 2 diabetes each year.

The cause of type 2 diabetes is also not known but excess weight and inactivity, along with genetics and environment factors appear to be contributing factors. Type 2 diabetes can be significantly prevented or delayed with proper nutrition and exercise.

It was a form of the disease that used to be seen primarily in adults, but is now rapidly increasing in people 20 and younger.

Monogenic Diabetes of Youth (MODY) is a third type of diabetes caused by mutations in the genes that control production of insulin. Like type 1 diabetes, MODY can’t be prevented.

The diabetes care teams at MU Health Care are multidisciplinary. The teams at Women’s and Children’s Hospital include a pediatric endocrinologist, diabetes nurse educator, diabetes dietitian, diabetes social worker and child life specialists. For adults diagnosed with diabetes, the specialists at the Cosmopolitan International Diabetes and Endocrinology Center at University Hospital work with patients and families from throughout Missouri and surrounding states to show them how to successfully manage the disease.

“Our goal is to teach diabetes self-management individualized to that child and his or her parent,” said Bachrach. “We teach them how to monitor glucose and give insulin injections early in the education, so we have a chance to watch and make sure they are understanding the processes. We want them to be experts and confident by the time they are discharged from the hospital after initial diagnosis.”

“With adult patients, we work closely with the patient’s primary care physician to craft the best possible diabetes care plan that is agreeable with the patient’s personalized overall health plan,” said Camila Manrique, M.D., MU Health Care endocrinologist and assistant professor of clinical medicine in the School of Medicine. “Raising awareness about diabetes is so important, because prevention and early diagnosis are key in delaying or preventing the appearance of diabetic complications.”

“Women are particularly affected by cardiovascular disease when diabetic, and the usual therapeutic strategies used in men might not be as effective in women,” said Manrique.

Researchers at the MU School of Medicine and the Cosmopolitan International Diabetes and Endocrinology Center are continually working on clinical research for treatment and a cure. Patients are offered opportunities to participate in many of the clinical trials.

“There is a lot of new information regarding the cell that produces insulin on both type 1 and type 2 diabetes,” said Manrique. “This new information likely will allow for the development of newer therapies to control the disease.”