An estimated 311,000 South Carolinians—or 12 percent of the state’s population—are affected by diabetes, and more than 3,000 deaths a year are diabetes-related. People with diabetes are four times more likely to have heart disease than those without it. It’s the leading cause of blindness in adults, ages 30 to 65. And it also puts patients at risk for stroke, heart disease, kidney disease and amputations.

To combat those consequences of diabetes, the Diabetes Initiative of South Carolina was created by the General Assembly in May 1994. A Diabetes Center of Excellence was created at MUSC, which serves as the program’s home base. The initiative’s purpose is to establish a statewide program of education, clinical research and translation of new diabetes treatment methods to serve the needs of people with diabetes—and the wide variety of health care professionals who care for them—throughout the state. John A. Colwell, M.D., Ph.D., serves as the MUSC Diabetes Center’s medical director, and the Diabetes Initiative’s board chairman.

Close liaisons have been developed between the initiative and the Diabetes Control Program of the state Department of Health and Environmental Control, and the American Diabetes Association, South Carolina Affiliate.

Intensive Management for Patients

The MUSC Diabetes Center offers direct care and intensive management through the Intensive Diabetes Education, Awareness and Lifestyle (IDEAL) Type I and Type II programs. After patients have been evaluated for suitability in the program, they are managed by a team of physician specialists, nurse clinicians, counselors and dietitians. In-depth assessment, teaching and day-to-day management are stressed. A team member, usually a nurse clinician, is on call 24 hours a day.

The program focuses on the fact that if a patient’s blood sugar is out of control, even a little improvement will decrease the risk of complications. That’s based on findings of the Diabetes Control and Complications Trial, a 10-year study that involved more than 1,400 subjects at 28 centers, including MUSC. The trial, which ended in June 1993, showed intensive therapy that keeps blood sugar levels close to normal reduced damage to the eyes by 76 percent, to the kidneys by 35 to 56 percent, and to the nerves by 60 percent.

Assistance for South Carolina’s Physicians

The Diabetes Initiative also focuses on assisting individual physicians throughout the state in providing the best care possible to their patients with diabetes. The initiative strongly advocates use of the glycohemoglobin test, which gives an overview of diabetes control over a roughly 60-day period, rather than the traditional overnight fasting blood glucose test, which gives a limited view. The GHb test, as it’s known, requires just a small amount of blood and can be collected at any time of the day.

Staff members of the MUSC Diabetes Center will visit physicians’ offices and provide office-based training. They’ll work with practices on developing chart flow sheets, guidelines for care and model patient education programs. They’ll also recommend literature appropriate for their practices. Continuing Medical Education seminars and training for diabetes educators and support group leaders is available, as well as Foot Care Education Program at MUSC.

For consultation or referrals, call MUSC Health Connection at 792-1414.

Editor's note: The article is reprinted from MDialogue newsletter, a physician liaison program publication.