One disease the state rates poorly at handling is diabetes,
despite the fact that West Virginia
has one of the highest rates of the disease in the nation.
The West Virginia Diabetes Prevention and Control Program
web site estimates nearly 229,379 West Virginians have diabetes and 62,162 are undiagnosed.
Yet according to the
Federal Healthcare Quality report the state is weak at providing care to
Dr. Hoyt Burdick, West
Virginia Medical Association president elect, said there’s a direct
correlation between diabetes and the state’s high obesity rate.
“Behind that wave of obesity is what’s called type 2
diabetes where there’s an insulin resistance caused by being overweight,”
Burdick said. “So when you put the obesity factors into this equation you’re
going to have a higher incidence of diabetes.”
Harpers Ferry Family Medicine is a large clinic that sits
just a few blocks off the main road in the historic town. Dr. Konrad Nau, a
family practice physician and dean at the Eastern Division of West Virginia
University’s medical school, helped start the practice 30 years ago.
Today the clinic has more than 300,000 patient visits a year
and Nau says one of the main ailments doctors here deal with is diabetes.
“This is one of those diseases where patients make a
decision about their diabetes many, many, many times a day,” Nau said. “Every
time they not only pick up their medicine and decide am I going to be able to
take it or not but when they pick up their fork, when they go to the grocery
store, when they pick up something to drink they’re actually making a decision
about their diabetes.”
Nau said managing diabetes 24 hours a day seven days a week
is difficult. Even when he prescribes the best medications many times patients
come back for follow up appointments with high blood sugar levels.
“And peeling away the layers of what do you thinks
contributing to that, and I get all kinds of answers to that and they’re very
honest heartfelt answers and sometimes patients actually get emotional about
it,” Nau said.
Patients have told Nau insurance doesn’t cover their
medicine any more, or the co pay went up, or a family member who isn’t as
careful about selecting the healthiest food has taken over cooking duties.
Harpers Ferry Family Medicine gives extra help to diabetes
patients. There’s a certified diabetes educator on the staff who meets with
newly diagnosed patients to teach them how to monitor blood
sugar, take medications and eat properly.
The practice also has group office visits for these patients
so they can share their experiences.
“We recently actually studied it and found that that group
is a much higher percentage of those patients are meeting all the national
targets for diabetes care than they are from the sort of traditional model of
diabetes care,” Nau said.
According to Nau the poor showing in diabetes care is linked
to other diseases that the report says West Virginia
is weak at treating.
“Because with diabetes often goes high blood pressure, and
with high blood pressure goes a risk for heart attack and stroke, with obesity
and diabetes goes high cholesterol. It sort of is a cascade of the metabolic
changes that occur once this condition sets in,” he said.
Nau says WVU’s medical school is addressing the problem by
having its third year students participate in a clinic with a primary care
physician half a day every week working with diabetic patients.
Other possible solutions include creating more opportunities
in communities for people to change their eating habits and lifestyle by adding
parks, sidewalks and programs that teach about healthy cooking.
Burdick thinks the Affordable Care Act that was recently
upheld by the U-S Supreme Court might also provide some solutions. The act
would increase the number of people carrying health insurance and he says if
that happens they’ll have better access to care.
“So I think whether it’s a mandate, a tax, whatever it is,
having the ability of people to access health care and pay for it as they can
is an improvement because absent any detection, monitoring, prevention,
counseling, all of these things can only get worse,” Burdick said.
And Burdick expects changes in Medicare under the Act to
enable preventive services that were previously not covered like colonoscopies.
It also erases the so-called donut hole that forced seniors to pay more for
“I’m not a political proponent of the act itself or its
repeal but factually there are some good parts to that act that can impact the
things we’re measuring here in West Virginia,”
Nau’s office has taken steps toward lowering the diabetes
rate and helping those with the disease manage it. He’s confident West
Virginia can improve the scores in all areas on the
health care quality report.
“We’ve done it in the past,” Nau said, pointing out that at
one time West Virginia ranked
very poorly in care of premature newborns.
“And we turned that whole system around,” he said “It took
some time but the state did it in an organized way. And now we’re among the
best in that.”
“So we can do this with diabetes and associated illnesses
because we really have to it is going to create the biggest burden of illness
in not only our adults but we’re seeing overweight children get diabetes of the
adult variety,” Nau added.