Tag Archives: diabetes

Missing context in reports on diabetic amputations

Joe Rojas-Burke

About Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health. To help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network, Rojas-Burke will hunt for resources, highlight excellent work and moderate discussions with journalists and experts. Send questions or suggestions to joe@healthjournalism.org or tweet to @rojasburke.

Photo by Victor via Flickr

Photo by Victor via Flickr

People with diabetes in the lowest income neighborhoods of California were 10 times more likely to lose lower extremities to amputation than people with diabetes in the highest income neighborhoods, according to a new paper published in Health Affairs.

Many news outlets covered the story, but none that I read provided much context beyond repeating what the Health Affairs paper had to say, which is a shame because there’s a lot to report. Most ignored the disturbing racial disparity in amputation rates. (HealthDay News did note the study’s finding that less than 6 percent of diabetics in California are black, but they account for about 13 percent of amputations.)

The study authors mapped hot spots of diabetic amputation in Los Angeles and across California, where rates varied from less than one to more than 10 amputations per 1,000 people age 45 and older with diabetes in 2009. Continue reading

Covering news about screenings, preventive health recommendations

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

AHCJ webcastThe U.S. Preventive Services Task Force just released a recommendation that pregnant women be screened for gestational diabetes, even if they have not been previously diagnosed with type 1 or 2 diabetes.

The task force often finds itself in the news when determining what works and doesn’t work in screenings and preventive care.

Previously, it told healthy women not to bother with calcium and vitamin D pills, said many women could wait on mammograms until age 50 and recently clarified who might benefit from regular lung cancer screening tests. The task force’s work lies in translating medical evidence into clinical practice, which can be a difficult and contentious task. Its recommendations are often nuanced and misunderstood.

How does the group come to these determinations and how can you report on the science and not just the heat a recommendation generates? What is evidence-based medicine and how does the USPSTF use it to make recommendations on health care services?

In a Jan. 28 webcast, USPSTF chair Dr. Virginia Moyer and co-vice chair Dr. Michael LeFevre will explain how the task force works in an effort to deepen our reporting of upcoming task force recommendations. A Q&A with the doctors, moderated by AHCJ medical studies topic leader Brenda Goodman, will follow. Continue reading

Reporter shares how to integrate effects of social determinants in health stories

Joe Rojas-Burke

About Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health. To help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network, Rojas-Burke will hunt for resources, highlight excellent work and moderate discussions with journalists and experts. Send questions or suggestions to joe@healthjournalism.org or tweet to @rojasburke.

Rhiannon Meyers

Rhiannon Meyers

It’s easy to blame disadvantaged people for engaging in behaviors that put them at risk for developing diabetes.

Rhiannon Meyers, a reporter at The (Corpus Christi, Texas) Caller-Times, says that “Over and over again, I heard doctors blame our region’s high rates of diabetes and related complications on noncompliant patients unwilling to make the necessary changes to get healthy,” while she was reporting “Cost of Diabetes.”

But Meyers delved deeper and found there were environmental and social forces that contribute to higher rates of unhealthy behavior and illness. In the latest “Shared Wisdom,” she explains: Continue reading

Levey: Reporters can change health care debate by telling communities’ stories

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Noam Levey

Noam Levey

Journalists can do better educating the public about health reform and our system of health care, according to Noam Levey, a national health care reporter with the Los Angeles Times/Tribune Washington Bureau.

In the Journal of the American Medical Association, Levey offers some specific suggestions for improving public understanding of health policy, including presenting information in question-and-answer pieces, presenting issues in a less political context and relying on trusted sources rather than politicians. Continue reading

New concepts, resources added to oral health core topic pages

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Recent updates to AHCJ’s oral health core curriculum pages include explanations of home care and prevention of gum disease, including some information about what kind of toothbrush your readers, viewers and listeners should be using.

There also are new links to resources on oral health and diabetes and a new report about how many children covered by Medicaid are getting dental care in each state.

In the coming days, watch for a tip sheet about the associations between periodontal disease and diabetes. Together, the diseases affect millions.

R.I. program provides care outside hospitals in effort to reduce ER use

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Emergency department

Photo by KOMUnews via Flickr

Using community health workers to work with frequent emergency room visitors is showing some success in reducing ER use.

The latest installment of “Cost of Diabetes,” a yearlong series by Rhiannon Meyers of the Corpus Christi (Texas) Caller-Times, looks at what Rhode Island is doing to help prevent and manage diabetes.

A “Communities of Care” program pairs peer navigators, who are community health workers, with Medicaid patients who are seen in an emergency room four or more times in a year. The peer navigators “try to figure out why [the patients] keep going to the emergency room and help them access resources they need, from housing to transportation to doctors’ appointments. The peer navigators also continuously check in with patients to make sure they are seeing the doctor as needed and taking their prescriptions to avoid unnecessary hospitalizations.”

Officials at UnitedHealthcare, which contracts with Rhode Island Medicaid, say they’ve seen a 30 percent decrease in ER use and have possibly saved up to $600,000, according to preliminary results. And those results are prompting people to look at the program as a model, said Dr. Rene Rulin, medical director of Rhode Island Medicaid at UnitedHealthcare.

(Hat tip to Keldy Ortiz.)

Interactive tools, new apps being used to improve health care #ahcj13

Lori Houston

About Lori Houston

Lori Houston is an editor at Pacific Health Magazine. She is attending Health Journalism 2013 on an AHCJ-California Health Journalism Fellowship, which is supported by The California HealthCare Foundation.

Using technology in health care to interact with people certainly opens up new avenues of communication and yields more data than ever. The intriguing question of whether and to what degree such interactions actually influence health behavior and improve health remains to be answered. Panelists in a Health Journalism 2013 session on the topic shared their highly varied experiences in applying technologies and social media tools to address specific concerns.

To reduce hospital readmissions by ensuring that patients know what to do when they go home,. Brian Jack, M.D., chair of family medicine at Boston University School of Medicine Boston, created an interactive tool for patients as part an initiative called Project RED or Project Re-Engineered Discharge. Virtual patient advocates interact with patients at their bedside on a touch screen, reviewing discharge information to prepare patients, then confirming their understanding by asking questions. Patients express near unanimous satisfaction with the tool, finding it easy to use even for those who have never used a computer.

Project RED also introduced a checklist for hospitals to use with elements known to reduce readmissions, such as identifying correct medications and a plan for taking them, as well as an after-hospital care plan and color-coded calendar that patients and families love. Continue reading

Experts stress lifestyle changes as prevention, treatment for diabetes #ahcj13

Diabetes is prevalent in the United States, and the numbers continue to balloon.

In a Health Journalism 2013 session focusing on type 2 diabetes, a panel of experts discussed the threats of the disease, its growth and possible treatment. The panel was moderated by Tennesseean reporter Tom Wilemon.

Rich Siegel, M.D., co-director of Tufts Medical Center’s Diabetes Clinic, said that the threats of diabetes and obesity – or “diabesity” – in adolescents and young adults is a 21st century time bomb. According to a 2012 study from the National Health and Nutrition Examination Survey, diabetes among adolescents rose 23 percent from 2000 to 2008.

Siegel said the keys to combating type 2 diabetes are diet, activity and education. Medication plays a role, with both injectable and oral medication available. He added that, after 90 years of use, insulin is still the most effective treatment. Surgery can even be an option, but not a first option.

“The idea of surgery is towards the bottom of the list,” Siegel said.

David M. Nathan, M.D., director of the MGH Diabetes Center and Clinical Research Center and professor of medicine at Harvard Medical School, cited a 2012 Centers for Disease control study showing that 26 million people in the United States have diabetes, a majority of them with type 2 diabetes. This is about 8 percent of the population. He added that nearly 2 million cases are diagnosed a year and 72 million American are pre-diabetic. According to an American Diabetes Association, $245 billion is spent every year on the disease.

In treating type 2 diabetes, Nathan stressed the importance of treating for the long haul, focusing on prevention and avoiding complications down the road. He cited a Diabetes Prevention Program Outcomes Study that showed that lifestyle changes reduced the development of type 2 diabetes by 58 percent, more than medication or a placebo.

Osama Hamdy, M.D., Ph.D., the medical director of Joslin’s Obesity Clinical Program and an instructor at Harvard Medical School, estimated that the cost to treat diabetes will reach half a trillion dollars in the next 12 years. He also suggested lifestyle intervention for diabetes prevention and treatment.

Causes, consequences of Nashville’s diabetes hot zone

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In The Tennessean (and USA Today), Tom Wilemon has assembled a series of reports on what he calls “the diabetes hot zone,” “a cluster of predominantly African-American, inner-city neighborhoods where diabetes rates soar to more than double the Davidson County average.”

After establishing the outlines and perils of the hot zone in his first piece, Wilemon follows up by looking into the scarcity of transplants and pervasiveness of dialysis in the area.

Although organ transplants can occur between races, matches are more difficult to achieve for blacks. Transplant recipients must have similar genes in their immune systems to those of the donor. Otherwise, the body will reject the organ.

Whites account for 68 percent of all organ donors, while African-Americans account for only 14 percent, according to the U.S. Organ Procurement and Transplantation Network. Although the number of blacks and whites waiting for a kidney in 2011 was about the same, whites received just over half of kidney transplants that year, while blacks received less than a third.

Finally, he examines the causes of the diabetes epidemic and, in the process, wading deep into the “soul food” versus “fast food” debate.

Wilemon is a 2012-13 AHCJ Regional Health Journalism Fellow and wrote this story with support from USC’s Annenberg School of Journalism.

Women’s health and the ACA: Look beyond contraception

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

If you have been listening to the contraception debate in Washington (sort of hard to avoid, isn’t it?), you may be under the impression that preventive health for women equals contraception. Or contraception equals women’s preventive health. (We’re putting aside, for the purpose of this post, the debate about religion, conscience and the role of government).
Health Reform core topic

The Senate has defeated one bid to overturn the administration rule requiring employers to provide an insurance plan with first-dollar coverage of birth control, and it’s not clear what the House will do. But the issue is likely to percolate in Washington, state legislatures and the courts for some time to come.

The health reform law, and the regulations being developed to implement it, has a far more expansive definition of prevention and what it means for women’s health. Here are more details on the new regulations and a tutorial from Kaiser.edu. According to the new women’s preventive health rule, new health plans must cover, without cost-sharing, a lot more than the pill:

  • well-woman visits;
  • screening for gestational diabetes;
  • human papillomavirus (HPV) DNA testing for women 30 years and older;
  • sexually-transmitted infection counseling;
  • human immunodeficiency virus (HIV) screening and counseling;
  • FDA-approved contraception methods and contraceptive counseling;
  • breastfeeding support, supplies, and counseling; and
  • domestic violence screening and counseling.

These requirements will go into effect in August (with another year allowed to finalize how the religious exemptions will work). Grandfathered plans won’t have to follow the new rule, while they maintain their “grandfather” status. Over time, many health plans will go through changes that will mean that they will no longer be “grandfathered.” Then they too will have to follow the new regulations.

Of course, more women will get these benefits, simply because more women will be insured. Approximately one in five women of reproductive age is currently uninsured. Most of them will get coverage, including preventive services, starting in 2014 whether through Medicaid, through subsidized coverage in the exchanges or by buying coverage. Right now, coverage of maternity benefits is spotty on the individual insurance market, but the plans in the health exchanges will cover it.

The law also requires many other preventive services – some free – for men, women and children. They have not gotten much attention in the polarized birth control debate.

The conversation (and press coverage) about the contraceptive rules have included lots of misinformation about abortion. Politicians who misstate policy don’t help, but reporters need to know what the law does and does not do.

The health law does not mandate abortion coverage and this preventive health rule does not change that. In fact, states under health reform have the explicit ability to limit abortion coverage in policies sold in state exchanges and several have already taken action to do precisely that. Plans that do cover abortion in the exchange will have to wall that off in a way to keep it apart from the federal subsidies.

Joanne Kenen

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

A few more stray but relevant facts:

According to the Kaiser.edu materials, about two-thirds of women aged 15 to 44 use contraception – and do so for about 30 years.

Most employer-based insurance plans do cover contraception, though there are often co-pays. Among large employers, more than 80 percent cover contraception.

Federal Medicaid dollars do not cover abortion under the Hyde Amendment (except for rape, incest or when the life of the mother is in danger) – although some states use their own money to cover abortion in some circumstances. But Medicaid does cover contraception. In fact, Medicaid pays for more than 70 percent of publicly financed family planning services.

And Title X funds family planning clinics (created in 1970 under the Nixon presidency). According to HHS, about 5 million women and men get family planning services through more than 4,500 community-based clinics. Someone with religious objections to providing contraceptives for employees is indirectly paying for Medicaid birth control coverage – and indirectly for the tax subsidies of employer-sponsored insurance – just as we all pay taxes that fund some things we agree with and some we don’t.