Diabetes. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when linked to a primary diagnosis of diabetes and performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Office visits to an Endocrinologist (diabetes specialist) for consultation and management of diabetes • Office visits to a Podiatrist (foot specialist) for consultation for routine diabetic foot care • Palliative Care Conversations (chronic condition treatment preferences) with a Primary Care Provider or Endocrinologist • Nutritional counseling up to six (6) visits per year • Diabetes education (with certified diabetes educator) • Diabetic (dilated) eye exam performed by Optometrist/Ophthalmologist will be covered once a year • Targeted laboratory test for the routine management of diabetes • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 150 every 30 days or 450 every 90 days at $0 Out-of-Pocket Cost Please note, if you have complications from diabetes and use an emergency department or urgent care center, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps, continuous glucose monitors and associated supplies are considered Durable Medical Equipment (DME); they are not covered under the CISP benefit and they are subject to applicable Plan cost-sharing terms. SAMPLE
Diabetes. Expanded pharmacy coverage is limited to $0 Out-of-Pocket Cost select Tier 1 preferred generic medications and a reduction in Out-of-Pocket Cost for select Tier 2 generics and Tier 3 preferred brand medications as outlined below. On plans that apply a Deductible for Tier 2 and Tier 3 medications, the Deductible is waived and the Coinsurance or Copayment is reduced by half. On plans that have a copay for Tier 2 and Tier 3 medications, the copay is reduced by half. Select medications used to treat diabetes that are specified on our formulary and are approved by the federal Food and Drug Administration (FDA) are covered under this reduced Out-of-Pocket Cost benefit. Select medications included in the reduced Out-of-Pocket Cost benefit will be designated on the formulary as Chronic Illness Support Program medications and must be filled through the Home Delivery Program described in section 2.G.7. Medications we specify for inclusion under this program are among the most effective and of the highest value to treat the Chronic Illness as determined by us. The following services related to diabetes are covered with $0 Out-of-Pocket Cost when performed by a Network Provider (unless otherwise noted): • Office visits to a Primary Care Provider for routine management of diabetes • Endocrinology consultation and management of diabetes • Podiatry consultation for routine diabetic foot care • Nutritional counseling, diabetes education and behavioral modification counseling • Diabetic eye exam will be covered once a year • One glucometer each year as specified on the formulary and dispensed through our Home Delivery Program • Glucose test strips listed on formulary and dispensed through our Home Delivery Program: up to 50 every 30 days or 150 every 90 days at $0 Out-of-Pocket Cost. • Laboratory services linked to a diabetes primary diagnosis code and considered routine for the management of diabetes. Please note, if you have complications from diabetes and use an emergency department, have a Hospital stay, or get treated for heart or kidney problems, the usual and customary Plan costs for these services apply, and will be subject to standard Out-of-Pocket Costs as outlined in your Schedule of Benefits. Insulin pumps and supplies are considered Durable Medical Equipment (DME).
Diabetes. 1. With an indicator of a Diabetes diagnosis, a participant is eligible for up to two additional dental visits in a Benefit year for periodontal maintenance or adult prophylaxis.
Diabetes. 8) Head Trauma (recent) within the past 6 months that required medical evaluation
Diabetes. Diabetes is a group of diseases which affect the way the body uses blood sugar. A diabetes diagnosis means a person has too much blood sugar, which can lead to other, more serious, health complications [2]. Diabetes was considered a high health concern in the community survey. Approximately 20% of survey respondents indicated they have diabetes, and more than a third reported that they have not had their blood sugar tested in the past three years. In the Parkview region the prevalence of diabetes ranges from 10.3% for Xxxxx County to 21.5% in Xxxxxxx County. Diabetes has both preventive and clinical interventions recommended by healthcare providers and professionals. Table 9: Diabetes Xxxxx Xxxxxxxxxx Kosciusko LaGrange Noble Wabash Xxxxxxx Diagnosed Diabetes % 10.3% 12.7% 10.4% 11.2% 11.8% 19.3% 21.5% Death rate diabetes* 0.02% 0.02% 0.03% 0.02% 0.02% 0.04% 0.03% *Age-adjusted
Diabetes. The patient will be made aware during the pre-operative clinic that diabetes increases their risk of infection and in some cases definitely has an effect on the surgical outcome and can cause progression of retinopathy. The following additional action will be undertaken at the pre-operative assessment as part of the assessment: the patient’s blood sugar will be measured. If blood glucose control is poor the patient will be educated regarding the importance of good blood glucose control, particularly in the pre- operative period. the patients will also be asked to bring along their BM diary to evaluate the long term control of these patients (this request will be included within the patient information booklet and detailed within the patient letter inviting the patient to attend pre-operative assessment). if the blood glucose is over 20mmol/L the patient will not be given a date for surgery but will instead be referred back to their GP. The GP will be asked to re-refer the patient once they have improved blood glucose control and are ready for surgery. The danger of having high blood glucose on the day of surgery is that it theoretically increases the risk of infection post-operatively. There is very little evidence on which to base guidelines, particularly following cataract surgery because Endophthalmitis is so rare. Reasonable precautions will be taken by the Provider to minimise infection on the day of surgery including: measuring blood glucose on the day of surgery. If more than 20.0 mmol/L surgery will be deferred and the patient referred back to the GP. the GP will be asked to re-refer when the patient is ready for surgery. Re-referral processes will be agreed between the PCT and the Provider. if the measurement is more than 15 mmol/L but less than 20mmol/L the Provider’s surgeon may proceed with surgery after explaining the higher risk of infection to the patient and obtaining their consent the consultant ophthalmologist will always be informed if the blood glucose is above15 mmol/l. Hypertensive patients All patients will have their blood pressure measured at the cataract pre operative assessment. If the systolic BP is over 185 or the diastolic is over 95 mmHg the patient’s surgery will be deferred and they will be referred to their GP for monitoring and blood pressure control. The Provider will define the BP thresholds for those not known to be hypertensive and ensure that they use the last reading of three over a 10 minute period. O...
Diabetes. Type 2 diabetes develops when the body does not produce enough insulin or the insulin that is produced does not work properly. This type of diabetes is treated with a healthy diet and regular physical activity, though medication (and/or insulin) is often required. In both instances each child may experience different symptoms and these should be discussed when drawing up the healthcare plan. What is the Treatment for the Condition? For most children diabetes is controlled by injections of insulin each day. Some children may require multiple injections, though it is unlikely that they will need to be given injections during school hours. In some cases, the child’s condition may be controlled by an insulin pump. Most children can manage their own injections, however, if doses are required at school then supervision may be required and a suitable, private place to inject will need to be identified. It has become increasingly common for older children to be taught to count their carbohydrate intake and adjust their insulin accordingly. This means that they have a daily dose of long-acting insulin at home, usually at bedtime and then insulin with breakfast, lunch and evening meal, and before substantial snacks. The child is taught how much insulin to give with each meal, depending on the amount of carbohydrate eaten. The child is then responsible for administering injections and the regime to be followed would be detailed in the individual healthcare plan. It is essential that children with diabetes make sure that their blood glucose levels remain stable. They may check their levels by taking a small sample of blood and using a small monitor at regular intervals. They may need to do this during the school lunch break, before PE or more regularly if their insulin needs to be adjusted. The majority of older children will be able to undertake this task without assistance and will simply need a suitable place to do it. However, younger children may need adult supervision to carry out the test and/or interpret the results. When members of staff agree to administer blood glucose tests or insulin injections, they should be trained by an appropriate health professional, usually a specialist nurse with clinical responsibility for the treatment of the particular child. What Arrangements are in Place at our School? Healthcare Plan A healthcare plan will be needed for pupils with diabetes. Information about these plans is given on page 6 and Appendix 2. Children with diabe...
Diabetes. 1.2.1 The nature of diabetes Diabetes mellitus is a lifelong condition that results in the blood sugar level of an individual becoming higher than it should be, i.e., hyperglycaemia (NHS, 2020). Diabetes is described as two types: 1 and 2, the second of which is the primary concern in SMI. In brief, type 1 diabetes mellitus (T1DM) is caused by an auto-immune mediated loss of insulin- producing ‘beta’ cells in the pancreas. T1DM is not caused by diet and lifestyle and the causes are still not fully understood (Xxxx et al., 2014). In addition, gestational diabetes mellitus (GDM) should be noted, as another manifestation not specifically the focus for this thesis. This describes high blood glucose levels during pregnancy accompanied by insufficient insulin production. Typically, women with GDM do not have diabetes prior to the pregnancy, and it normally resolves after giving birth (Diabetes UK 2021). It is recommended that pregnant women should be offered a test for diabetes if they have any of the following risk factors: overweight/obese status, GDM in a previous pregnancy, a previous baby heavier than 4.5kg at birth, a family history of diabetes, and being a member of particular ethnic groups (African Caribbean, Middle Eastern, South Asian) (Diabetes UK 2021).
Diabetes. 7. Kidney or liver disorders.
Diabetes. It is a condition of chronic hyperglycaemia as a result of insulin resistance and pancreatic beta cell dysfunction - insulin resistance describes the biological lack of sensitivity to the peptide hormone insulin secreted by the pancreatic beta cells. When beta cells are not able to secrete sufficient quantities of insulin in order to reduce glucose level, this is termed beta cell dysfunction. Either extreme insulin resistance or beta cell dysfunction is sufficient to cause diabetes – the depletion of pancreatic beta cells in type 1 diabetes (T1D) can be considered an extreme from of pancreatic beta cell dysfunction. Moreover, rare and severe forms of insulin resistance are known (Xxxxxxxxx et al., 1998, Xxxxxx et al., 2011). With the development of T2D, the increasing lack of tissue sensitivity to insulin and compensatory increase in insulin secretion is not adequate to decrease the blood glucose levels, which if left unchecked, is toxic and ultimately results in irreversible nerve damage and organ failure. Himsworth (1936) first recognised diabetic individuals could be classified into insulin sensitive and resistant phenotypes. The first report by the World Health Organisation (WHO) on diabetes in 1964 initially classified diabetes by age of onset; this was later changed in their 1980 report by distinguishing the two major types of diabetes by insulin sensitivity. As more was learnt about diabetes, new diagnostic methods were introduced along with re-evaluation of the diagnostic criteria, the latter being reclassified on many occasions, which has an impact on historical epidemiological comparisons of prevalence and incidence. It was thought that insulin resistance was the primary pathogenic trigger in T2D, requiring tissues to demand ever-increasing amounts of insulin. It is now recognised that predisposition to beta cell dysfunction is likely to be a pre-existing condition within individuals that go on to develop T2D - insulin secretion is ostensibly adequate in the context of high insulin sensitivity and the inability for compensatory insulin secretion is hidden at this stage. Only as peripheral sensitivity to insulin decreases, does this beta cell defect become apparent. This current view has been is supported by a recent study from Xxxxx et al. (2009), in which they investigated the relationship between insulin resistance and pancreatic beta cell function prior to T2D onset using longitudinal data collected for approximately a decade on more than 6,50...
