November is American Diabetes Month

by Karen M. Winston

Diabetes is the seventh leading cause of death in King County. The risk of diabetes increases with age, and this condition is associated with serious complications, such as vision loss and kidney disease. Since 2000, Aging and Disability Services (ADS) has been working to develop a Diabetes Registry for homebound clients in our case management program. The Area Plan on Aging 2004-2007 includes an objective to increase the number of clients in the case management program whose chronic diseases are under control, such as diabetes.

What is a Diabetes Registry?

A diabetes registry, aka Diabetes Electronic Management System (DEMS), is a system that documents the care and management of participants with diabetes. A diabetes registry contains information on enrolled participants who have been diagnosed with diabetes within a program or medical setting. The registry allows the organization or team responsible for diabetes treatment and care to fully automate the planning and delivery of care and interventions.

ADS uses its registry to track information on diabetic clients, monitor important medical information, coordinate lifestyle interventions, and provide education and support to clients. The registry also benefits program planning, since we can identify migration patterns of clients throughout King County and other system-wide trends.

What interventions do clients on the registry receive?

Good nutrition, physical activity, and medication management are central elements of every treatment plan for people with diabetes and ADS case management clients are no exception. ADS provides nutrition therapy and physical activity, and is now enhancing an intervention to assist clients in managing their medication regimen.

ADS currently partners with Bastyr University and Shoreline Community College to coordinate medical nutrition therapy for clients on the registry. Interested clients receive a series of regular home visits from supervised student dietitians. These students assist clients with evaluating their diets and nutritional needs. For the physical activity intervention, ADS partners with the University of Washington School of Rehabilitative Medicine. Graduate Physical Therapy (PT) students provide home visits to interested clients and conduct pre- and post-assessments, develop an action plan with appropriate physical activities and exercises, and monitor each client's progress.

How have clients responded to the interventions?

Although many case management clients have high levels of functional disability (approximately 80 percent use assistive devices) they showed marked improvements as a result of these valuable interventions, according to a recent study. For example, one 82-year-old client who did not exercise regularly was at risk of losing functional independence. Following the PT intervention, the same client was able to perform therapeutic exercises with good technique and control, and even began a regimen of physical therapy twice a month at a nearby clinic.

The ADS Diabetes Registry illustrates the effectiveness of community partnerships in providing needed, cost-effective services for homebound elderly and disabled adults with diabetes.

For more information about the ADS Registry, contact MaryPat O'Leary, Seattle Case Management Program Supervisor, at marypat.o'leary@seattle.gov. Also, see the Public Health Data Watch on Diabetes for King County.

To read more about living with Type II diabetes the form most common in older adults see the article "Living with Type II Diabetes" in this issue of Seniors Digest.