Story by Jennifer Zingalie, U.S. Naval Hospital Guam Public Affairs
Staying in control is important; diabetics probably know that better than most. In March U.S. Naval Hospital Guam (USNH) stood up a Diabetes Clinic to provide more comprehensive care to patients with uncontrolled diabetes. The clinic is run by a doctor, a corpsman and a Diabetes Nurse Educator. Additional support includes staff from the Optometry, Podiatry and Nutrition Departments.
“Our goal is to decrease the amount of patients with uncontrolled diabetes by improving our patient’s health,” said Lt. Dustin Smith of USNH Guam’s Family Practice Clinic. “In helping them control their diabetes, we decrease their risk of heart attacks, we improve their quality of life and overall health,” said Smith, who’s also tasked with getting the Diabetes Clinic off the ground.
According to Smith, uncontrolled diabetes is when a person has an A1C greater than 9. However, for some diabetics this number can also be dependent on other medical issues and their goal A1C may be less than 7 or 8. A1C is glucose (sugar) attached to hemoglobin, a protein found in red blood cells that transport oxygen to the body. A test is performed to measure the average blood sugar a person has over a two to three month period, the higher the number, the greater a person’s risk of complications such as heart disease.
While the clinic is getting established, it is only accepting patients with an A1C greater than 9 who are enrolled in TRICARE Prime. Patients are being contacted by Hospital Corpsman 2nd Class Frederick Glenn to schedule an appointment with the Diabetes Nurse Educator. Eventually the clinic has plans to expand to all patients with uncontrolled diabetes.
The Diabetes Clinic will also be in line with the Medical Home Port concept, with diabetes patient care being managed by their primary care manager (PCM). According to Smith, a diabetic with uncontrolled diabetes should be seen every three months. However, the Diabetes Nurse Educator will be available for more frequent contact and closer interval follow ups within the time they are not being seen by their PCM. The Nurse Educator will also be able to help assess the amount of control being implemented for the diabetic and provide recommendations for medication adjustments and other things that can provide better overall support to the patient.
Smith said that on Guam, there tends to be a higher number of incidents of diabetes, and the hospital also sees a large number of younger patients with diabetes. Because the Navy evaluates how hospitals manage patients in areas such as screening and chronic medical issues such as diabetes, the diabetes clinic will also allow the hospital to more efficiently track these patients.
“Because uncontrolled diabetics need to be seen more often, there can be a tendency for them to fall through the cracks,” said Smith. “The Diabetes Clinic will ensure more contact with patients, in the hopes that with more frequent contact the patient will in turn be seen or contacted by someone on a regular basis. We care about their health and we want to make sure their diabetes is being properly controlled.”
Even though the clinic’s focus is those with uncontrolled diabetes, the Diabetes Nurse Educator will also provide group classes and educational opportunities for people with all types of diabetes. In the meantime, Frederick will continue to contact patients with uncontrolled diabetes to ensure they are up to date on their screenings such as a physical, foot, and eye exams.
“The ultimate goal is self management,” said Smith. “We want to empower the patient and give them the tools they need, to self manage their diabetes. Sometimes that is just a simple reminder that they need to.”