As a nurse, Bill Fay was all too familiar with the primary consequences of uncontrolled diabetes: blindness, missing limbs and toes, kidney failure, heart disease.
This is why Fay, who is now Director of Practice Administration and Infection Control at Open Door Care Network, has been so enthusiastic about the federally-qualified health center’s performance enhancing project this past year that was created to ensure that patients with diabetes are seen more frequently for eye appointments and retinal scans, are regularly monitored for their A1C levels, and evaluated for their kidney health.
One of the project’s priorities is reducing diabetic retinopathy (DR), the leading cause of blindness among working aged adults in the U.S., and a primary consequence of uncontrolled diabetes. Nearly 10 million Americans suffer from DR, nearly two million of whom are threatened with the loss of vision. The eye disease, which is often asymptomatic, is caused by high blood sugar that damages retinal blood vessels. It affects a significant percentage of people with both Type 1 and 2 diabetes.
“If they can catch the disease early enough,” said Fay, “they can control it.” The results of bringing patients in for eye exams and monitoring their A1C levels (with diet and exercise programs and providing medication), he said, has been extremely positive, with compliance rates exceeding New York State guidelines.
A room in Open Door’s Ossining facility is dedicated to its OCT machine ((Optical Coherence Tomography), a non-invasive diagnostic tool, that uses light waves to capture high-resolution cross-sectional and 3D images of biological tissues. This allows it to identify the swelling of tiny blood vessels in the retina caused by diabetes and for patients to get earlier treatment (which focuses on slowing or stopping progression, managing symptoms, and preserving vision through blood sugar/blood pressure control, laser therapy or surgery).
Blacks and Hispanics are hit hardest by vision-threatening DR (more than twice as much as whites). This is due, experts say, to poor glycemic control among those with diabetes, the earlier age at diabetes diagnosis and longer disease duration, and disparities in the quality of care.
“Diabetes is a high impact, chronic disease, especially with our folks,” said Fay. “It runs rampant in our population, which is why we take these services seriously and work so hard to get these people in through the door. Our project has been successful in meeting our goals. The human impact of diabetes hasn’t changed since I was a nurse, but it’s great when you see people under control.”
