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Continued from cover Specialized Diabetes Centers Focus on Prevention can be detected with simple, noninvasive tests and is easier to treat in the early stages of disease, before the optic nerve becomes too damaged and the visual field (peripheral vision) becomes significantly impaired, according to Dr. Nouri-Mahdavi. “In some patients, by the time we catch glaucoma progression, the patient has lost significant vision unnecessarily,” Dr. Nouri- Mahdavi says. “We have to detect glaucoma earlier so we can intervene earlier. But this is no easy task.” Dr. Nouri-Mahdavi recommends that some patients be evaluated once every six months with visual fields, rather than annually, for continued damage to the eye. Using data from the Advanced Glaucoma Intervention Study, Dr. Nouri-Mahdavi and his colleagues at JSEI recently demonstrated that increasing the frequency of testing led to earlier detection of glaucoma progression in some patients. They published their findings in the Archives of Ophthalmology. “Not every glaucoma patient needs intensive monitoring and follow-up, but we found that six-month follow-up was preferable in selected patients,” he says. Once disease progression is detected, the treatment includes adding eye drops or performing a procedure called laser trabeculoplasty. It uses a high-energy beam of light to facilitate fluid drainage from the eye and lower the intraocular pressure. Alternatively, some patients need surgery to decompress the eye and significantly bring down the eye pressure. “We now have many tools in our toolbox to detect and treat glaucoma,” Dr. Nouri-Mahdavi says. “If patients are seen regularly and comply with their doctor’s instructions, the chances of going blind from glaucoma are actually very low.” This team-based approach, along with the individualization of therapy to the patient’s social and economic circumstances, is what distinguishes the UCLA Diabetes Program, says diabetologist Jennifer Han, M.D. “The future of diabetes care is to target people with earlier-stage diabetes as well as those with pre-diabetes so that we can prevent complications from occurring.” Although a number of medications are important to the treatment of diabetes, lifestyle factors — including healthy nutrition, physical activity and self- monitoring — are vital strategies. “It all boils down to patients wanting to change their health,” Dr. Han says. “With our team-based approach, there is accountability, consistency and people there to make sure patients are doing the best they can.” Many patients assume that medication alone will keep their blood-sugar levels in check. “Diet and physical activity work synergistically with medication to control diabetes,” says Shiri Morgan, M.P.H., R.D., C.D.E., a dietitian and certified diabetes educator in the program. “You need to do everything.” Dietary strategies depend on the patient, but typically include reducing carbohydrate portions to prevent peaks in blood sugars. “A diabetic diet is, in reality, a heart-healthy diet,” Morgan says. “You can eat normal foods; you just have to watch how those foods affect blood sugar and make adjustments.” The introduction in recent years of new technology to assist with diabetes management at home — including insulin pumps and continuous glucose monitors — provides patients with more information and greater flexibility, but also more responsibility for their care, notes Evelyne Fleury-Milfort, N.P., a nationally recognized diabetes educator and nurse practitioner supervisor at the UCLA Diabetes Program. “This increases the importance of education, because if patients do not have a good understanding of how to use the new technology, it can potentially be harmful,” Fleury-Milfort says. While type 2 diabetes is preventable, there are certain factors such as family history or borderline levels of blood sugars that might put a person at higher risk for the disease. An evaluation from a center like UCLA’s might help patients to determine their level of risk. More so than in many chronic diseases, decisions made by individuals who have developed diabetes go a long way toward determining their health. “Our role is to help patients become active participants in their care by giving them the knowledge and skills to make informed choices,” Fleury-Milfort explains. “The better we can educate patients and support them through one-on-one as well as group classes, and increase their participation in their care, the more likely they are to lessen the incidence of complications and enjoy a good quality of life.” For more information, go to: Vital Signs Winter 2013 Vol. 57 7