Recognizing the importance of consistent diagnosis and treatment, Lancaster General Medical Group (LGMG) instituted a Staged Diabetes Management (SDM) Program five years ago. Lancaster General Medical Group consists of 16 family practice and specialty physician offices in 19 locations throughout Lancaster County.

By the end of the program’s first year, there were 2,000 enrollees. Now there are more than 6,000 and the program continues to grow by at least 20 percent each year. “We are one of the largest community-based diabetes programs in the country,” says Dr. David Bowers, Medical Director of LGMG. “We have twice been recognized as one of the 10 Best Diabetes Programs in the country, according to an Athena Health System study.”

One of the biggest reasons for the growth of the program is the consistent screening guidelines developed for SDM. These guidelines were developed in accordance with the American Diabetes Association’s (ADA) standards of medical care. SDM provides a common approach to the treatment of diabetes but gives room for individual variation. Physicians now have a greater awareness of the risk factors associated with diabetes and are more likely to screen for potential cases. Once a person has been diagnosed as having diabetes, the first step is to educate the patient on his disease and to develop a medical management program. The program provides evidence-based treatment guidelines and logical, more intensive treatment regimens when the desired goals are not met.

Wanda Mumma discovered she had Type 2 (adult onset) diabetes four years ago while she was pregnant with her daughter Elizabeth. Before that point she had been a borderline diabetic. Then during her pregnancy, she needed to give herself insulin shots.

“When I had to give myself insulin injections, it really shed some light on what it means to have diabetes,” Wanda says. “I decided that I would take whatever steps I could to make sure that I don’t ever have to do that again, if possible.”

Wanda now controls her diabetes through medication, modified diet and exercise. She meets with Dr. Michael McGee, New Holland Family Health Center, every three months for blood sugar checks and routine screenings including vision and foot exams.

“Since the time of her diagnosis, Wanda has adopted the SDM philosophy of aggressive and tight control of her diabetes. She has become educated about her disease and is active in monitoring its control and participating in her treatment. As a result, she’s achieved good control of her sugars, which will have a positive impact on her future health,” Dr. McGee says.

In the SDM program, after being diagnosed with diabetes, Wanda’s next step was to make an appointment with the Lancaster General Diabetes & Nutrition Center. There, registered nurses and dietitians specializing in helping people with diabetes educated her on the disease and how to successfully manage her blood sugars. For Wanda, the meeting was illuminating.

“I learned quite a bit about diabetes that I didn’t realize before,” she says. “I figured that I would need to watch my sugars, but I didn’t realize I would also need to watch the amount of carbohydrates I ate. The dietitians explained that carbohydrates can turn into sugar, so now I try to limit the amount of breads and noodles that I eat.”

Dr. McGee says that education is one of the most important parts of the SDM program. “The SDM approach strongly emphasizes patient education and the use of diabetic nurse educators and dietitians to provide patients with the information they need to take charge of their disease.”

Since being involved in the SDM program, Dr. McGee says he has “become more aggressive in my treatment approach to the disease. Diabetes can easily lull both patient and physician into complacency. In the early years of the disease, the patient usually feels completely fine, but less than optimal control of blood sugars will inevitably lead to devastating complications years later. My involvement in the program has provided me with more of a sense of urgency. Also, by its adherence to the American Diabetes Association guidelines, it provides a framework to remind me what things need to be checked on a regular basis.”

Dr. McGee is one of the many Lancaster General Medical Group physicians who have wholeheartedly embraced the SDM program. Besides the increasing numbers of patients being enrolled, 70 percent of the patients have reported reductions in blood sugars, thereby decreasing their reliance on insulin and other medications, says Dr. Bowers. The average improvement in blood sugar is 15%, which translates to a significant reduction in long-term complication rates. Long-term complications could include kidney disease, blindness, vascular disease, heart attacks and amputations.

Dr. Charles Rost, Medical Director of the Diabetes and Nutrition Center, says, “SDM has helped our primary care physicians by establishing common treatment guidelines and goals. It provides encouragement for aggressive diabetes care and appropriate, timely referral for specialty care. There is an emphasis on patient education and participation in the disease management process. SDM enables our physicians to act proactively for their patients to achieve better health and an improved quality of life.”