Published in UAB Insight, Summer 2008
Annual Evaluation, Recommendations Offered in 1-day Visit
UAB's Multidisciplinary Comprehensive Diabetes Clinic (MCDC) opened this summer in The Kirklin Clinic® (TKC) to offer patients 1-day multispecialty evaluation, lifestyle education, and recommendations to guide their care from year to year.
The clinic provides services unique in Alabama and available at only a few centers in the nation, clinic director Fernando Ovalle, MD, says. "Our goal is to assist referring physicians in improving treatment and address the current epidemic of diabetes mellitus. The MCDC devotes more time and resources to patients than is possible in a general endocrinology practice, but the payoff will come with improved glycemic control, better patient follow-up, lower risk for micro- and macrovascular complications, improved quality of life, and decreased health costs in the long run," he says. An added benefit is the opportunity to offer patients entry into clinical research protocols through its Research Studies Unit.
Clinic faculty physician Stuart J. Frank, MD, director of the Division of Endocrinology, Diabetes, and Metabolism, says the diabetes service will continue to see patients for routine visits in its general endocrinology and diabetes clinic at TKC.
Endocrinologists, ophthalmologists, orthopaedic surgeons, nutritionists, and social workers are among the specialists available at the new MCDC clinic, with others on-call as needed. Patients see several specialists in one location in a single day. "Typically they would have 3 to 5 half-day appointments to accomplish what we do in one visit," Ovalle says.
Some patients are scheduled into one of MCDC's subspecialty clinics, including those for patients on insulin pumps or adolescents transitioning to adult care. Less frequent clinics are held for patients with cystic fibrosis-related diabetes, maturity-onset diabetes of the young, pancreatic diabetes, transplant-related diabetes, and other less common diagnoses.
One week before their appointment, some patients make a short visit to TKC for fitting with a subcutaneous sensor to continually monitor interstitial blood glucose levels. When patients arrive for their all-day appointment, those data are downloaded for evaluation. Patients undergo comprehensive fasting laboratory tests and then meet individually with a diabetes educator for an assessment of their current self-care knowledge and skills. Morning discussions help patients move forward with their diabetes self-care goals. A diabetes-appropriate lunch-and-learn session also is offered.
Afterwards patients rotate through in-depth specialty evaluations. At day's end, a clinical coordinator develops a comprehensive clinic note for the patient and their referring physician that provides evaluation data and recommendations for the next year's care.
Other MCDC faculty includes adult and pediatric endocrinologists Carlos R. Arguello, MD, Richard S. Rosenthal, MD, Amy H. Warriner, MD, Brooks Vaughan III, MD, Joycelyn A. Atchison, MD, and Kenneth L. McCormick, MD; ophthalmologist R. Jeffrey Crain, MD; orthopaedic surgeon John S. Gould, MD, and his faculty; nephrologist Ruth C. Campbell, MD; nutrition and diabetes educators Cathy E. Crawford, RD, CDE, Alison Wharton, RD, CDE, Mary Lou Ziroli, RD, CDE, and Jana Otwell, RN, CDE; and social worker Jessica E. Gifford, MSW.
Impact of Diabetes
Alabama:
- Alabama's diabetes rate is the fifth highest in the nation and the disase is the state's seventh leading cause of death.
- One in 10 Alabamians (360,912 individuals) have been diagnosed with diabetes; an additional 200,000 may be unaware they have the disease.
- In Alabama diabetes accounts for 3% of all deaths.
- The annual economic cost of diabetes in Alabama is $1.7 billion.
United States:
- 24 million people (8% of the population) have diabetes, a 3-million person increase in 2 years.
- 57 million Americans have prediabetes.
- Diabetes is the leading cause of blindness and accounts for 40% of the new cases of end-stage renal disease.
- Diabetes is the seventh leading cause of death in the United States.
- Annual economic costs related to diabetes exceed $174 billion.
The World:
- More than 246 million people worldwide have diabetes; that number is projected to reach 380 million by 2025.
- After India and China, the United States has the third highest number of people with diabetes in the world.
- Each year 7 million people worldwide develop diabetes and 3.8 million people die from the disease.
- Diabetes is the fourth leading cause of global death by disease, causing about 5% of all deaths each year.
Sources: 2007 data, Alabama Department of Public Health; Centers for Disease Control and Prevention; American Diabetes Association; World Health Organization; International Diabetes Federation.
FOR MORE INFORMATION:
Dr. Fernando Ovalle
Dr. Stuart Frank
1.800.UAB.MIST
mist@uabmc.edu