Diabetes: Mom’s life shines with team-based care

Linnea Welander grocery shops with her two young children.

As a staff nurse, Linnea Welander is accustomed to being around illness. But that familiarity did not begin with her patients; when Welander was 10 years old, her sister was diagnosed with type 1 diabetes (Type 1 occurs when the body does not make enough insulin; it accounts for 5 percent of all diabetes cases).

For years, Welander participated in a national study to monitor her risk for developing the same disease as her sister. When she moved to Iowa City six years ago, Welander was asked to participate in a similar follow-up study at the University of Iowa. At just her second appointment as a participant, Welander was diagnosed with type 1 diabetes. This was only  a month before she became pregnant with her first child.

Since her diagnosis, the now 30-year-old mother of two has worked with a team of UI specialists—including endocrinologists, researchers, dietitians, diabetes nurse educators, and obstetricians—to ensure that her diabetes care addresses her overall health.

Welander attended diabetes education classes at University of Iowa Hospitals & Clinics to master her insulin pump and has learned to adjust her insulin intake based on her daily diet and exercise and activity levels.

“Having access to all of the medical specialists, as well as having dietitians on board to meet with me, really helps me understand and manage my diabetes,” says Welander. “It’s nice that everything’s in one place and they all communicate together.”

The team-based approach to long-term diabetes care offers patients the best outcomes, according to E. Dale Abel, MD, PhD, an endocrinologist and director of the UI Fraternal Order of Eagles Diabetes Research Center.

“We have a system where we promote the well-being of the diabetes patient in an ongoing way,” he says. “The goal is to focus on getting patients to embrace the lifestyle and other changes that need to happen in order to successfully manage their condition.”

This ongoing, holistic approach to diabetes care at the UI benefits many patients like Welander, as well as patients who have been referred for specialized care.

“We manage our patients—particularly type 2 diabetes patients—intensively within the team, and when they meet certain goals, our approach is to we send them back to their primary care provider with a well-articulated care plan,” Abel says. “But we keep the door open if they need to return to us for any reason.”

Part of the care plan for type 2 diabetes patients includes medication. University of Iowa researchers, along with physicians at 36 other medical clinics across the nation, are participating in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study, which aims to determine the best combination drug treatment for type 2 diabetes.

“Type 2 diabetes gets worse over time, and we want to know through the GRADE study which medications will work for the longest period of time.” says UI endocrinologist William Sivitz, MD, who is the principal investigator at Iowa. “The idea is to see the effectiveness of preventing the deterioration of the diabetic state.”

According to Abel, ten to 12 percent of Iowa’s population has diabetes, and three times as many Iowans have prediabetes (higher than normal blood sugar levels but not high enough for a diabetes diagnosis). The combination of diabetes education, lifestyle changes, and medication is essential in keeping diabetes patients healthy.

Today, Welander visits the diabetes clinic at UI Hospitals & Clinics—Iowa River Landing every three to four months for routine check-ups. While managing her diabetes will be a constant focus in her life, she knows she has the support of a dedicated UI care team.

“The most successful patient with diabetes, whether type 1 or type 2, is the individual who takes ownership of the process,” says Abel. “Our goal as diabetes care providers is to empower our patients to ultimately manage their diabetes themselves.”

Two types of diabetes:  Type 1, representing only 5 percent of all cases, occurs when the body does not make insulin. Type 2 diabetes, the most common form, occurs when the body does not respond to insulin properly, and not enough insulin is made to compensate. For many type 2 patients, medication must be introduced along with improved diet and exercise regimes. Researchers at the University of Iowa and 36 other medical clinics nationwide are participating in a study to determine the best combination drug treatment for type 2 diabetes.

Under the radar: Nearly one in four adults with diabetes are unaware of their condition.

–Fall 2014