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To know that a person comes from a certain ethnic background does not tell us where they are in terms of their values and behaviors. However, it can alert us to possible arenas of miscommunication, and can lead us to closer observations about where they are in the development of culture change. In addition, the stages of intercultural sensitivity can be used for our own evaluation as we make interpretations of the behaviors of others. [ABSTRACT FROM AUTHOR]

The Carondelet Diabetes Care Centers continue to adapt to the needs of their clients and the institution. As a member of Ascension Health, Carondelet has committed to the goal of providing health care access to all. The Diabetes Program is an example of the outreach to all levels of clients-high or low risk, insured or noninsured, educated or noneducated. The challenge and the goal of the Sisters of St. Joseph of Carondelet continue through these outreach efforts. [ABSTRACT FROM AUTHOR]

For a diabetes DM program to operate effectively, leaders and administrators must take the time to acquaint themselves with all laws and regulations as well as accreditation and certification requirements that may be applicable. Failure to become familiar and follow applicable laws and regulations may not only impact payment for services, but also could subject your staff and organization to needless investigations and/or sanctions. This chapter has provided only an overview of the many laws that may be applicable to a given program. Those who operate DM programs would be well advised to invest the time and money in a full consultation with legal advisors who can advise more specifically about both state laws and changes in federal laws that may impact your organization. [ABSTRACT FROM AUTHOR]

Disease management offers the promise of reducing a portion of the high cost of care for the chronically ill by enlisting the full participation of the patient and informal support system and ensuring timely and appropriate high quality medical care to ensure optimal health. Even as studies are still underway to establish DM's impact on quality and cost in health plans and Medicaid PCCM based programs, DM is about to be tested in what has been considered the most formidable market, i.e., Medicare fee-for-service. As DM continues to evolve and to penetrate additional markets, it affects nearly every policy area in health services. Its definition as an administrative service or insurance benefit, the form of payment for DM services, DM's reliance on paraprofessionals or its reliance on nurses in new roles, the outsourcing ofDM or the building DM into existing health plans or newly created community care networks, the acceptance of DM practices into ongoing definitions of quality care and criteria for pay for performance suggest just a few of the policy areas affected by DM. More broadly, DM may be part of new "delivery system" for Medicare fee-for-service. In the same vein, whether Medicaid chooses to outsource DM to external companies or includes it as a component in a community-based and state integrated system may set a new course for Medicaid programs. Finally, a number of policy decisions will help to determine whether DM becomes just another service for the insured, or whether it becomes a central element in the prevention and management of chronic diseases across the larger population. [ABSTRACT FROM AUTHOR]

Innovations in technology have been making the lives of people simpler and better. Although some might argue that technology has had negative effects on health (e.g., televisions and cars have caused an increase in sedentary lifestyles), technology also can be used to improve people's health, raise their awareness of health issues, and facilitate health consultations with communities living in rural communities. [ABSTRACT FROM AUTHOR]

A plethora of botanical substances exist that affect diabetes. Many of the lesser known herbs presented are from the Ayurvedic or Chinese medical systems, and have been used successfully in other countries with good results, but without the benefit of the rigorous scientific study required in the United States. As the world becomes smaller, more of these traditional medicines may become available. It should be emphasized that while some of the most common modalities of CAM are presented, Naturopathic medicine, similar to Native American,Ayurvedic, or Chinese medical systems, does not operate solely by treating the disease. Instead, the emphasis is on treating the whole person. An individual with diabetes, for example, would likely receive some of the treatments outlined in this chapter. However, treatment would be individualized to that particular person, and other modalities such as homeopathy, counseling, acupuncture, bodywork (manipulation, hydrotherapy), and/or energy work (Reiki or another healing touch therapy) would be applied as well. It is precisely this individualization of treatment that make CAM medical systems so difficult to study in the reductionistic paradigm that guides current medical thinking. With time and understanding, however, medical systems rather than single treatments are beginning to be examined; it is hoped that this will continue in the future. [ABSTRACT FROM AUTHOR]

If we adhere to a systematic regimen of diagnosis and classification of risk factors for each individual patient while utilizing the multidisciplinary team approach that facilitates appropriate treatment of complications, this may ultimately lead to a reduction in both complications as well as lower extremity amputations as they relate to diabetes. [ABSTRACT FROM AUTHOR]

Sick days, surgery, and travel are situations in which routines are disrupted. Careful planning can help avoid diabetes complications during these challenging times. [ABSTRACT FROM AUTHOR]

The most effective management of diabetes will always involve medical, behavioral, and emotional components—a three-legged stool. Health care providers have a crucial role in helping patients with diabetes manage the emotional component. From dealing with common emotions to managing stress and nurturing family teamwork, the health care provider can consistently and gently help the patient along the path of living well with their diabetes. [ABSTRACT FROM AUTHOR]

The approach to managing type 1 and type 2 DM varies greatly; however, the overall goal is to attain glucose homeostasis. Patients with type 1 diabetes require exogenous insulin administration whereas, for those with type 2 diabetes oral medications and insulin are utilized. There have been large accomplishments in the area of diabetes treatments, as well as exciting research is underway that will provide knowledge and treatments to improve the quality of care for patients with DM. [ABSTRACT FROM AUTHOR]

Employing the CCM in collaboration with actual and virtual peers can help you transform the care you deliver to those with diabetes and other chronic illnesses by establishing: Well-developed processes and incentives for making changes in the care-delivery system.Behaviorally sophisticated self-management support systems that give priority to improving and sustaining patients' ability to manage their own care.Functional care teams and practice systems, such as appointments and follow-ups, to meet the unique needs of patients with chronic illness.Evidence-based guidelines and guideline supports through provider education, reminders, and increased and effective interactions between primary care physicians' and referral physicians' information systems—including disease registries, tracking systems, and reminder systems. [ABSTRACT FROM AUTHOR]