Medicaid patients with diabetes and hypertension need better outcomes. To achieve better outcomes, physicians need more consistent information on their patients’ real health behaviors. State legislators are pressing to get healthcare costs under control, while Medicaid administrators need to invest thinly stretched resources simultaneously in direct care and broad public health programs that will keep hospital readmissions down. As director of a network of managed primary care systems (Northern Piedmont Community Care) ...

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MKSAP: 78 year old woman is seen for management of her diabetes mellitusTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient's blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more ...

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As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system. With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based ...

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Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators. The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve ...

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I just returned home from mHealth Summit Meeting in DC which, in my opinion, is still one of the biggest and best mobile health conferences of the year. On the first day of the conference, I discussed the EndoGoddess App as a use case example of mobile health from the practicioner point of view. Sadly, the numbers of physicians in the mobile health entrepreneural space at mHealth Summit were still few and essentially unchanged ...

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Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term "fat," "obese," or "morbidly obese" because they were stigmatizing, blaming, and the least motivating to ...

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MKSAP: 55 year old man to undergo coronary artery bypass graft surgeryTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin ...

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Recently, our whole class was asked to "become" a diabetic to try and really understand what it is we’re diagnosing people with.  Fantastic idea.  Fantastic opportunity. Not so fantastic to carry out.  I opted for the insulin-dependent, type I option, which meant I had to keep a diary of what I ate (including counting carbohydrates), regularly check my glucose level, and inject myself before meals. (We didn’t actually inject insulin or saline, ...

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In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic.  Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000.  When you consider that type II diabetes has a strong genetic component – the risk for a ...

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A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm.  Her blood sugar level was extraordinarily low, so low that she would have died had she not received immediate treatment. The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit ...

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