St. Joseph center helps patients manage diabetes

The first hospital-based diabetes center in Nashua opened earlier this year at St. Joseph Hospital, allowing patients with the chronic disease to receive much of their care under one roof.

Part of a national trend in health-care delivery, the center allows a diabetes patient to see a nurse practitioner, a nurse educator, a registered dietitian and other specialists who work together to manage the patient’s disease and prevent potential complications.

The center, which opened in August after the hospital hired nurse practitioner James Harris to head the team, operates as part of St. Joseph’s cardiovascular program. It is a response to a growing incidence of the disease among both adults and children in New Hampshire and across the nation.

“Diabetes is reaching epidemic proportions,” said Carolyn Perrault, a certified diabetes educator who has counseled patients with diabetes at the hospital for the past 12 years. “There’s a lot more out there and more being diagnosed.”

According to the American Diabetes Association, 18.2 million Americans had diabetes in 2002 — 13 million who were diagnosed and 5.2 million who were not diagnosed. In addition, experts say a growing segment of the population is pre-diabetic, meaning that without intervention they could develop diabetes or some of its complications.

There are two types of diabetes: Type 1 diabetes, previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes, and Type 2, once called non-insulin-dependent diabetes mellitus, and now known as adult-onset diabetes.

Type 1 usually strikes children and young adults. It develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that produce insulin, a hormone that regulates blood glucose.

Type 2, which experts say accounts for between 90 percent and 95 percent of all diagnosed cases of diabetes, usually begins as insulin resistance, a disorder in which the cells do not use insulin efficiently. As the need for insulin increases, the pancreas gradually loses its ability to produce it.

Type 2 is associated with age, obesity, family history, prior gestational diabetes, inactivity, impaired glucose tolerance and race. African descendants, Latino Americans, American Indians, some Asian Americans, native Hawaiians and other Pacific Islanders are at higher risk for Type 2. But an increasing number of children and adolescents are being diagnosed with Type 2, according to the American Diabetes Association.

Overall, according to the ADA, the risk of death for people with diabetes is about twice what it is for those without the disease.

Perrault said the numbers alone are reason enough for taking a team approach to managing diabetes.

“For a long time, I did the program alone, helping them understand about the disease, the disease process, how to control it with meal plans, exercise, medication, how to monitor blood sugar,” she said. “With a nurse practitioner, we can do better at management of the disease process.”

Diabetes is manageable, but cannot be cured, said Perrault, describing the condition as a progressive disease.

“There’s a lot of frustration because you can do it all perfectly (nutrition, exercise, medication) and your blood sugar doesn’t respond correctly,” she said. “It’s the nature of the disease.”

But management makes a significant difference.

Harris, diabetes manager for the new team, said his goal is to help patients avoid the serious complications of the disease, which can lead to grave conditions including heart and kidney disease and blindness.

Harris said he can’t stress enough the value of eating right, exercising, taking medication and monitoring. The more adherent a patient is, the better the long-term prognosis, he added.

Likewise, technology has brightened prospects for patients with diabetes.

“Being in the diabetes world, I have found it to be very exciting,” Perrault said. “It has grown tremendously – technology (like) the insulin pump gives patients better control of blood sugar and prevents the complications.”

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