Discovery Health report on CME Cardiometabolic Risk Factors: Hitting the goals.
The doctors interviewed talked about case management strategy using web
based surveys.
Over one-third of adults in the U.S. have two or more cardiometabolic risk
factors, which are overweight, insulin resistance (diabetes), high blood
pressure, and dyslipidemia (cholestorel-HDL/LDL). Millions of people with any
combination of these factors are at risk for cardiovascular disease.
Doctors need to take the BMI and the waist circumference earlier and use diet
and exercise more than they are doing and their patients will do much better in the long
run.
Blood pressure targets should be less than 130/80, although 140/90 is acceptable
in healthy, non-risk patients.
Blood sugar (fasting) < 100
Glycemic index < 7%
The National Cholesterol Education Program recommends:
LDL primary target < 100 mg/dL
Less risk patients may be < 130
HDL > 40 mg/dL (men)
HDL > 50 mg/dL (women)
Raising HDL is 3 times as powerful.
Triglycerides <= 150 mg/dL - hard to manage - not managed by statins - must add
niacin or fibrate when really they should talk about lifestyle first.
Women & diabetes patients have higher risk with hypertriglyceridemia, and
especially women with diabetes, are showing an increase in cardiovascular
mortality.
In the Reach Registry, international population based registry of patients with
cardiovascular disease, more than 67,000 enrolled, 55% of them have poorly
treated hypertension, 5% had undiagnosed hypoglycemia. A significant majority
that had significant risk factors were overweight or obese.
2004 study by
Saudek and Colleagues (Johns Hopkins) - reaching blood pressure goals and A1C goals
just over 35% and cholesterol goals of < 200 was less than 50%, and with all
three goals - 7.3%. HDL is at 24 to 25% of where we want it to be.
“The first step in preventing
or delaying the onset of complications associated with diabetes is
recognizing the risk factors, including uncontrolled blood glucose,” added
Saudek. “Assessing glycemia in diabetes can be a challenge, but
approaches are available that promote successful management of blood glucose
and may lead to a significant reduction in incidence and in medical
treatment of diabetes.” One of these, of course, is web and/or IVR
surveys.Doctors in Louisa, VA, state
that it's much easier to take a medication than it is to incorporate
exercise and diet into the patients' lifestyles.
We know that the longer we allow CME to go untreated or partially treated, the
more cardiovascular damage occurs. There is only so much you can do - you
can share information, tell them the consequences, but ultimately they have to
make the decision to change their behaviors.
These doctors recommended a low fat diet with 1500
calories per day for women, 1800 for men and 150 minutes of exercise per week
(minimum). Start slow - use FIRM (Few Changes Individualized
Recommended to be Made). The patient must pick the changes or It's too overwhelming, so
you set them up for success by picking modest goals they will certainly achieve
and finally, you have to monitor those results. If you're not tracking,
you don't know what's going on.
The three doctors being interviewed all agreed that
doctors are not trained in approaching patients about their lifestyles and those
that learn on their own are not being successful in affecting lifestyle changes
without referring to third party, non-physician support (ex: trainers) and/or
using case management strategies including web surveys to give them feedback.
They all agree that it's important to FOLLOW UP!!!! These changes need
support over time to be accomplished.
The IPT
solution provides an online approach for lifestlyle
wellness solutions by facilitating doctor patient interaction / communication in managing
routine diet and exercise regimens. In many cases, this negates the need to prescribe
costly medications that are often associated with unpleasant side effects. With monitoring,
better outcomes are proven and everyone is more satisfied - the patient with their care, the doctor with their results,
the managing clinic or hospital system with their satisfaction factor and/or P4P analysis.
|