BARRY WILLIAMS/Special

Linda Simmons, left, and Kimberly Roberts check the diet history of patients at the WellStar Health System’s Diabetes Education Center in Marietta.

Most people think of diabetes as a disease associated with blood sugar counts and insulin, not as the nation's fifth-leading
cause of death.

About 17 million Americans have been diagnosed with diabetes. The disease accounts for one out of every four dollars spent in health care and significantly increases the risks of developing cardiovascular disease, hypertension, kidney disease and blindness in those who have it. The number of people who have diabetes in the United States is growing every year.

Three years ago, the Volunteer Hospital Alliance chose WellStar Health System as one of eight national sites to launch its Target Diabetes program. Well-Star has been fighting diabetes and its consequences ever since, and the major weapon in its
arsenal is education.

"In Georgia, the prevalence of diabetes is 8 percent higher than the nation as a whole. It is estimated that almost 10 percent of all Georgians have diabetes, and one out of three are not even aware they have the disease," said Kimberly Roberts, RN, BSN, Target Diabetes specialist with WellStar Health System.

WellStar took a four-pronged approach to the problem, addressing it in the clinical hospital setting and in outpatient physicians' offices, raising community awareness and teaching diabetics to manage their disease.

"We initiated strict glycemiccontrol guidelines in our critical care units at Douglas, Cobb and Kennestone hospitals, based on
national research conducted by the national Target Diabetes committee," said Linda Simmons, RN, director of disease
management at WellStar. "We've seen excellent results, with nurses able to get patients' blood sugar levels down to normal
range within six hours and keep them there, thereby reducing the mortality and morbidity rates."

WellStar's A1c test average for its patients has dropped from 8.2 percent in 1999 to 6.86 percent at the end of 2005. The A1c test is used primarily to monitor the glucose control of diabetics over time.

WellStar formed a multidisciplinary steering committee of nurses, doctors, nutritionists, pharmacists and others who worked with diabetic patients to oversee the initiative. They've worked with The Center for Healthcare Transformation, public health departments and other agencies to launch a community education effort to increase the public's knowledge about the disease.

The health system also set new standards of care for outpatient physicians, employees and affiliates of the hospital, and it
monitors the results through chart reviews.

"We want to be known as a center of excellence for the delivery of diabetes care," Roberts said.

WellStar has established four American Diabetes Association certi fied centers to help outpatients manage their diabetes. At
each hospital, certified diabetes educators run the centers.

"It can be very depressing to be diagnosed with a chronic disease," Roberts said. "We give our patients the tools they need
to understand diabetes and encourage them to control it.

"We're not the diabetes police. Our job is to motivate, educate and encourage them to take tiny steps - like not eating
that bowl of ice cream at 2 a.m. - and to praise them when they succeed."

WellStar's efforts not only have helped diabetics reduce their health risks but also may have prevented others from getting
the disease.

Roberts was inspired to make diabetes a specialty by a friend who didn't control his diabetes well. He got a tiny pebble in his shoe, and, because he couldn't feel the pebble, he got an infection that spread throughout his whole body.

"Through lack of education and self-management, a good, kind man lost his life to diabetes," Roberts said. "I think about
that when I walk in the door in the morning."

Roberts also thinks about a young diabetic mother who ended up in a WellStar ICU because of a postpartum infection.

"She was very ill, but because we had an intensive insulin program, she walked out of the hospital and is back with her family," Roberts said.

More than just an initiative, the fight against diabetes has become part of the WellStar culture and has touched all aspects
of care, Simmons said.

"We're passionate about this program and really proud of the results. The initiative is not going to go away," Simmons
said. "It's exciting to be part of a health care system that wants to and is making a difference. We're making huge strides in
creating a healthier community."

"But we have our work cut out for us," Roberts added. "Everyday we see new patients, and it's like starting all over again. Every patient is important, which is what keeps us motivated to keep working."