The American Diabetes Association has published standards as to terms of the care and management of diabetes. If these are complied with they provide the means to bring the blood sugar of most diabetics under control. The combination of daily testing of blood sugar by the patient and the regular testing of glycosylated hemoglobin by the doctor provide the information to allow adjustments in insulin to bring blood sugar levels as close as possible to that of a non-diabetic. The failure of a doctor to implement that type of regimen is probably diabetes malpractice.
It is high levels of blood sugar, particularly in the small blood vessels that serve sensitive areas of the body like the kidneys and the peripheral nerves in the hands and the feet and the retina of the eye that is particularly destructive. Typically patients that are informed of the destructive mechanism of diabetes and the ease with which it can be controlled become faithful in their own testing habits. The key is getting that information to the patient both for the well-being of the patient and to avoid diabetes malpractice.
The American Diabetes Association has been especially forthright in setting forth what these basic standards of care are. They encourage all physicians to bring them to the attention of patients and to enforce them within their own practice.
In a study published in March of 2011 from the University of Texas Health Science Center in San Antonio it is reported that people who took a new drug marketed under the brand name of Actos were less likely to develop diabetes than a similar group who was given a placebo. Actos is from the same class of drugs as Avandia which had been found to increase the risk of heart attack. Actos is believed to be safer than Avandia but it has been linked to increased risk of congestive heart failure and the Food and Drug Administration is looking at possible links to bladder cancer. Questions continue to remain as to whether or not this drug in fact prevented diabetes or simply is masking it by lowering elevated blood sugar levels.
Any diabetes malpractice analysis is a two-way street, i.e. you not only look at the fault of the physician but you may also have to look at the conduct of the patient.
Diabetes is sometimes called the life style disease principally because your risk of getting this blood sugar disorder is increased if you live an unhealthy life style. If on the other hand you follow a healthy diet, exercise and control your blood pressure, weight and cholesterol then the risk of getting diabetes is considerably reduced.
There are several things that can be done in that regard:
Part of the reason that our health care system is so expensive and, according to some dietetic professionals, actually “broken” is because the system is focused on dealing with symptoms as opposed to dealing more with preventive maintenance.
That preventive maintenance comes principally in the form of diet control and good exercise.
One of my daughters, Andrea Roche, has a Master’s Degree in Nutrition from Simmons College in Boston and is a registered dietitian.
What follows is an article that she recently published in a publication of the Massachusetts Dietetic Association dealing with the issue of including registered dietitians in the recently enacted Affordable Care Act.
Accountable Care Organizations (ACOs) have become the buzzword of the medical industry: The passage of the Affordable Care Act (ACA) has set the American healthcare system on a new course with ACOs leading the way, and Dietetic professionals must get on board. The Academy of Nutrition and Dietetics (AND) must be a proponent of ACOs, and take the necessary actions to secure Registered Dietitian (RD) participation and inclusion, establish incentive alignment with the payment system, and conduct quality measures. Currently, RDs are not listed as providers that can form an actual ACO, though the issue has not been greatly discussed. In light of this shift, the greater inclusion and active participation of RDs in every component of this comprehensive health policy is essential. In order to achieve greater inclusion, RDs must be informed of the advantages and have greater accessibility into an ACO network.
The ACO framework impacts our profession in two distinct ways: (1) a reorientation of the health care system towards prevention and wellness, and (2) a movement towards a patient-centered approach to treat chronic disease through a reformed payment and delivery system, relying on increased primary care providers, medical homes, and community-based health centers.
Essentially, an ACO is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. The fundamental goals of this model are twofold. First, a reduction in per-patient cost and disease-related complications. And second, an increase in patient experience satisfaction, utilization of resources, and transparency and interoperabililty. These goals are based on a shared care model. In reference to dietetics, all healthcare professionals and RDs may work collaboratively to provide nutrition services aimed at prevention, treatment, and management of nutrition-related problems. In addition to their role in critical care, dietitians are also involved in health promotion, disease prevention and early intervention strategies, interdisciplinary collaboration, establishing links with community services, and a wide range of research. RDs’ specialized knowledge, skills, and experiences allow for the provision of numerous services that complement and augment those of other healthcare professionals involved in patient care.
The role of nutrition and the registered dietitian on the ACO team directly correlates with the comprehensive care process as outlined by its design. RDs are the experts in delivering Medical Nutrition Therapy (MNT). Through evidence-based practices, MNT services for prevention, wellness, and disease management, have proven to be effective. Furthermore, the Institute of Medicine recently declared that “the registered dietitian is currently a single identifiable group of health-care professionals with standardized education, clinical training, continuing education and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy.”  Registered Dietitians are cost-effective, quality care providers, and there is substantial evidence attesting to this. For example, Massachusetts General Hospital in Boston reported that patients who had received MNT in a 6-month randomized study experienced a 6% decrease in total cholesterol, including LDL cholesterol levels, compared with a control group (who did not receive MNT), which reported no reduction in cholesterol. Furthermore, a cost-saving of $4.28 for each dollar spent on MNT was reported.  The Lewin Group reported that RD administered MNT results in an 8.6% reduction in hospital utilization, and a 16.9% reduction in physician visits per year. Additionally, the same report revealed a 9.5% reduction in hospitalization, and a 23.5% reduction in physician visits for patients with diabetes mellitus.  It is clear that including RDs as providers of ACOs, increases quality of care and cost-effectiveness.
The ACO model shows promise as a driver of both quality improvement and cost control, via care coordination. The intent of the ACO to improve both quality and control costs, can be better realized with the inclusion of RDs as professional providers. I encourage dietietic professionals to continue to pursue research regarding ACOs, in order to better secure our inclusion in this new wave of healthcare reform.
 Committee on Nutrition Services for Medicare Beneficiaries “The Role of Nutrition in Maintaining Health in the Nation’s Elderly; Evaluating Coverage of Nutrition Services for the Medicare Population”, Washington, D.C.: Food and Nutrition Board, Institute of Medicine, January 1, 2000.
 Delahanty L.M., et al. Clinical and cost outcomes of medical nutrition Therapy for hypercholesterolemia: A controlled trial J. Am. Diet Assoc. 2001;101:1012-1016.
 Johnson,R. The Lewin Group: What does it tell us, and why does it mattter? J. Am. Diet Assoc.; 1999; 99: 426-427.