Tuesday, October 28, 2008

A Tale of Two Diabetics

Meet Homer. His appetite for doughnuts and aluminum wrapped carbonated carbohydrate-rich beverages has finally caught up with him. His doctor has told him that he's overweight and has diabetes mellitus. An oaf he may be, but he’s a lovable well-meaning oaf who does his best to follow his doctor’s advice most of the time. He’s been told by his doctor about the role of diet, exercise, medications and regular follow-up. He remembers little of it.

Homer’s neighbor Ned hasn’t been immune from exposure to Fatland either. A victim of one too many yummylicious Church suppers, his waist line has also reached critical mass. He is very attentaroonie to the need for blood glucose control, has bought a meter and is already thinking of giving that eye professional he saw just last month a call to see if there was any sign of a new word he learned on line i.e., ‘retinopathy.’ He’s been told by his doctor about the role of diet, exercise, medications and regular follow-up. He’s tried to remember what he’s been told. He remembers little of it.

Who is going to have the better outcome – Ned or Homer?

While Ned is the obvious choice, don’t dismiss Homer, especially if he gets the kind of health care coaching that is tailored to his life-style preferences. While it’s always hard to predict just how Homer will process things, given his preferences, he’d probably be reluctant be hassled by the polypharmacy combination of medicines of dubious value and heightened risk of side effects that only marginally lower his A1c to that one-size-fits-all guideline value of 7.0% or lower. While he’ll probably neglect getting his yearly eye examination, chances are likely that his vision will do just fine. Because he works at a nuclear power plant, Mr. Burns – not out of any soft hearted notions of niceness but out of a hard assessment of a likely return on investment - has probably invested in an aggressive on-site wellness program that has made donuts far less available. Last but not least, Homer is high risk and has been tagged by a disease management organization as someone that warrants regular phone calls. Homer’s nurse has determined that Marge can be a resource in modifying Homer’s dietary habits.

By-the-book Ned, in the meantime, is probably going to go along with the ADA recommendation that he get his A1c below 7%, even if he has to take a combination of three different medicines to do it. While he’s worrying about all those side effects, the increase in his visits to the doctor is going to prompt additional testing and referrals for other long dormant conditions, including that vague pain he’s had in his low back and his concern that that long standing mole could be something serious. And by the way, Ned’s business pays for a bare bones health insurance program with a high deductable and no disease management support. There are no on site wellness programs and Ned doesn’t have access to any disease management.

The DMCB will put it's money on Homer.

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