Pulse
Target: DiabetesKathy Marshall knows the power of education in the fight against diabetes. Diagnosed when she was 7, Marshall has lived with diabetes for 30 years.
"I was very young and very scared at the time. What I heard in diabetes was the word 'die,' " said Marshall, RN, CDE, coordinator of diabetes education at Southern Regional Health System in Riverdale.
 Photos by BARRY WILLIAMS/Special |
| Kathy Marshall, coordinator of diabetes education at Southern Regional Health System in Riverdale, speaks to newly diagnosed diabetes patients during a two-day class. Marshall was diagnosed with diabetes when she was 7. |
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| Cris Hartley, manager of Gwinnett Medical Center's Diabetes and Nutrition Education Center, shows how to administer insulin. |
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| Part of diabetes education is showing patients the supplies they need to monitor and manage their disease. |
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| Newly diagnosed diabetes patient Donald Crawford and his fiancée, Sherene Collis, listen during a diabetes education class at Southern Regional Health System in Riverdale. |
Fortunately, her parents learned how to manage the disease and changed the family's lifestyle. They took the healthy approach; Marshall ate right and exercised and has never suffered from the complications that diabetes can cause.
"My parents are in their 60s and [are] extremely healthy," she said. "If everyone acted like a person with diabetes and followed the guidelines for eating and living, we'd have a much healthier population."
Marshall taught dance before turning to nursing in 1991.
"I had a very personal interest in wanting to help others [who are] diagnosed with diabetes, especially children, so I started nursing in pediatrics," she said.
The disease has reached alarming proportions in the United States; almost 21 million people have been diagnosed with diabetes. About 7 percent of the U.S. population has diabetes, and the percentage is higher (about 9.1 percent) in Georgia, Marshall said.
More than 29 million Americans are projected to have the disease by 2050, according to WellStar Health System's Diabetes Services. Diabetes is the sixth-most-common cause of death in Georgia.
People who don't manage their diabetes well are at greater risk for heart disease, high blood pressure, stroke, blindness, kidney failure, amputation and other complications.
Marshall has made it her mission to fight diabetes. She is a certified diabetes educator, has co-chaired the Georgia Hospital Association special interest group on diabetes, and has been on the board of the Greater Atlanta Association of Diabetes Educators.
"I started looking at diabetes care around Georgia and knew we could improve," she said. "I wanted Southern Regional to be a pioneer and on the cutting edge of diabetic care. Our leaders have been very supportive of our initiatives."
For the last five years, Marshall has helped to make diabetes a priority for hospital staff by shepherding new policies and procedures that benefit patients.
"We have diabetes-focused rounds once a week. About 40 percent of our med-surge patients have diabetes," Marshall said.
A multidisciplinary staff of doctors, nurses, educators, dietitians and case managers reviews all patients who have diabetes — regardless of why they're in the hospital — to make sure their blood-sugar levels are under control.
"No matter what the patient's diagnosis, if his diabetes is not controlled, he won't do as well," Marshall said.
Since starting the diabetes-focused rounds, the hospital has had a decrease in hyperglycemia among patients (from 35 percent to 23 percent). Southern Regional also has seen fewer infections and shorter hospital stays.
Two years ago, the hospital instituted new protocols for treatment of high blood pressure and patients who use insulin-infusion pumps. Because of a new IV insulin-drip protocol, the length of stays for Southern Regional patients with insulin pumps has decreased by 1.6 days over the last nine months.
The hospital also has reduced incidences of diabetic ketoacidosis, a serous condition caused by insulin deficiencies and poorly controlled diabetes.
Many hospitals, including Southern Regional, provide community diabetes screenings, outpatient classes and counseling for diabetics, and lectures about diabetes risk factors (such as age, inactivity and obesity).
Managing diabetes
In response to the growing number of diabetic patients, Gwinnett Medical Center in Lawrenceville opened its Diabetes and Nutrition Education Center 10 years ago.
"We were seeing more and more people with diabetes and knew we could make a difference with education," said Cris Hartley, RD, CDE, manager of the center. "Ninety-nine percent of managing diabetes is self-management. People can delay or prevent complications by the choices they make."
The center, which is accredited by the National Diabetes Association, offers newly diagnosed patients individual counseling and diabetes-management classes in English and Spanish. Certified diabetes educators (nurses or registered dietitians) teach patients how to measure blood-sugar levels, take their medications, dose and inject insulin, and check their feet for sores. Patients also learn how diet and exercise can help them stay healthy.
"The disease progresses individually for each patient, but in a class, people help each other find solutions for problems," Hartley said. "At the end of the class, we ask them to choose one thing that they can do to help manage their diabetes. For most, it's their diet or exercise. We call them every three months to see how they are doing on their goals."
Hartley worries about the increasing number of children diagnosed with Type 2 diabetes, knowing that complications could set in early in their lives. She also is troubled to see so many diabetes patients without insurance and with little access to health care or education. The center keeps a list of free and low-cost clinics and other resources for low-income patients.
Power of prevention
One reason that diabetes education is so important is that many people are like walking time bombs.
"Helping people with pre-diabetes is another huge issue. There are estimated to be 41 million people in the country with higher blood-sugar levels," said Ruth Ann Schultz, RN, CDE, a WellStar Health System outpatient diabetes educator. "If those people don't get into a class and learn how to control their numbers and change their lifestyle, every one of them will develop diabetes."
With proper education and treatment, 58 percent of those with high blood-sugar levels would not develop diabetes, according to the American Diabetes Association.
A former high school teacher, Schultz is well-suited to work with the TARGET: Diabetes Program at WellStar, which was one of eight pilot sites for the Voluntary Hospitals of America's program. The program fights diabetes by providing specialized training for hospital nurses, physicians and patients and by raising awareness in the community. The main weapon in the program's arsenal is education.
"Ninety-five percent of diabetes control is what you do every single day on the home front," Schultz said. "You can control your glucose levels, but without education, patients have no idea how to do that."
She sees as many as 50 new patients per week enrolling in the WellStar Kennestone Hospital classes. The average patient receives an individual assessment and nine hours of class time.
"Our patients come out with skills to manage their disease and can take a refresher course annually," Schultz said.
The staff makes follow-up calls to patients. One man told Schultz that his diabetes diagnosis shook him to the core but that, through the visual aids in class, he began to understand what was going on in his body and how to deal with the disease.
"He was energized and motivated by the classes and made dramatic changes in his life," Schultz said. "That's what you want to hear — that they got it."