$15 Million Texas Experiment

The residents in one Dallas, Texas neighborhood are much more likely to die of diabetes than other neighborhoods in the same county. Poverty adds it’s own wrinkle, but one costly experiment seeks to discover if a prevention program can be developed to overcome daunting odds.

$15 Million Texas Experiment: The residents in one Dallas, Texas neighborhood are much more likely to die of diabetes than other neighborhoods in the same county. Poverty adds it’s own wrinkle, but one costly experiment seeks to discover if a prevention program can be developed to overcome daunting odds.

Baylor’s Diabetes Health and Wellness Institute opened the Diabetes Health and Wellness Institute, a health center that cost millions of dollars to develop. The city of Dallas chipped in $2 million as a health investment in this south Dallas neighborhood. Dallas Mayor Tom Leppert referred to the facility as a “passport to health”.

When you consider that direct and indirect costs associated with diabetes totals more than $12 billion in Texas each year you can see that a $2 million investment is perhaps conservative. However, if the program ultimately works it could spread in the Lone Star State and around the country.

According to the Dallas Morning News Baylor’s Diabetes Health and Wellness Institute, “Includes a full-time physician; a pharmacy with lower-priced medication; nutrition and healthy cooking classes; a farmer’s market with fresh fruits and vegetables; and exercise and weight training programs.

“Their experiment pits money and a comprehensive wellness program up against poverty and unhealthy lifestyles.”

According to the report Baylor believes that preventative care will ultimately be less expensive than emergency room care and they are hoping the data will ultimately confirm their initiative.

There’s actually a lot riding on the success or failure of this Texas-sized experiment. According to the Dallas Business Journal, “Congresswoman Eddie Bernice Johnson, D-Dallas, representing the state’s 30th congressional district. [She] spoke at the event, where she emphasized on the significance of preventative health care, adding that with the new diabetes center, Dallas has positioned itself as a model to the rest of the country.” If the program fails then it contradicts many of the presuppositions in the new Health Care Reform Act.

How Bad Is It In The Neighborhood?

The average annual income in this targeted area is just over $14,000. Some make less than $10,000 a year. The result is very little regular physician care coupled a diet that relies on calorie rich, but inexpensive foods. The combination means obesity among the poor in this south Dallas neighborhood.

The initial idea for the facility was unveiled in 2006 and the Baylor board has indicated they have been solidly behind the experiment.

Because Baylor is a non-profit hospital they must spend 20% of revenue from patients on what is known as “community benefit”. Some may argue this is simply a way to spend that money, but Baylor claims a more thoughtful approach to this experimental facility.

Baylor CEO Joel Allison is quoted by the Dallas Morning News as saying, “Health care organizations need to expand their role in the community, and this initiative is one example. Hospitals have not traditionally been in the business of providing cooking classes, farmers markets, treadmills and computer labs. But this new model of care represents the future.

“We are now working to improve the health of a community beyond the walls of the hospital.”

Diabetic residents are already taking advantage of the new program and have expressed gratitude that the facility is geared toward their neighborhood.

And as many eyes watch the program plans are sure to follow for other facilities if this should prove successful.

Diagnosing Diabetes

Diabetes is normally diagnosed by running one of a number of chemical tests on either the urine or the blood of the patient…

Diagnosing Diabetes

Diagnosing diabetes is normally done by running one of a number of chemical tests on either the urine or the blood of the patient. The following are the more common tests used to diagnose diabetes.

Testing For Urinary Glucose

A non-diabetic person loses undetectable amounts of glucose in the urine whereas a person with diabetes loses glucose in small to large amounts, in proportion to the severity of their disease and the number of carbohydrates they consume. Simple tests can detect glucose within a urine sample and so can confirm the presence of diabetes however if a positive result is recorded a more complex quantitative laboratory test will be carried out in order to establish the severity of the condition.

Fasting Blood Glucose And Insulin Levels

A fasting blood glucose level in the early morning of around 80 to 90mg per 100 ml is considered to be normal, and a level of 110mg per 100ml is taken as the upper limit of normal. Anything above this value often indicates diabetes mellitus.

In type I diabetes, the insulin levels measured in the blood plasma are very low or undetectable during fasting and even after a meal. However, in type II diabetes, the plasma insulin concentration maybe three or four times higher than normal. Either way, the concentrations detected by the clinical tests will be abnormal and so can be used as an indicator of the disease.

Glucose Tolerance Test

When a normal fasting person ingests 1 gram of carbohydrate per kilogram of bodyweight their blood glucose level rises from an average of 90mg per 100ml to around 120mg per 100ml. Following this rise, the level then drops back to normal in around 2 hours.

A person with diabetes however has an average blood glucose concentration of around 120mg per 100ml even before ingesting the carbohydrate. After ingestion, their blood glucose concentration can rocket to over 200mg per 100ml and it takes anywhere up to 6 hours for it to drop back down to around its starting level.

This slow fall and its failure to drop to normal levels demonstrate that either:

  1. The normal increase in insulin secretion that normally occurs after glucose ingestion is impaired
  2. There is a decreased sensitivity to insulin. Measuring the concentration of plasma insulin will distinguish type I from type II diabetes (see above).

Acetone Breath

Small quantities of acetoacetic acid in the blood are converted to acetone in severe cases of diabetes. This is a volatile acid and is expired as an individual breathes out. Consequently, a physician can often diagnose type I diabetes simply by smelling acetone on the breath of a patient.

Keto Acids In The Urine

In diabetic individuals, keto acids can often be detected by chemical means in the urine and their quantification can help to determine the severity of the disease.

Swift diagnosis of diabetes means that treatment is received as early as possible. Many of the diagnostic tests can be done by your regular doctor which means that if you are at all worried that you may have a form of diabetes, one quick visit to the doctor will be able to put your mind at ease.