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Blanketing the state with information about the latest diabetes prevention and management guidelines is the top priority of the Texas Diabetes Council for the next three years, says the San Antonio podiatrist recently appointed by Gov. Rick Perry to chair the panel.

Lawrence Harkless, DPM, plans to travel the state asking health care professionals and community resources to link together in a diabetes "dragnet" that catches every case early in the disease process. Dr. Harkless is the Louis T. Bogy Professor in Podiatric Medicine and Surgery at The University of Texas Health Science Center at San Antonio (UTHSC). He also directs the highly regarded podiatry residency training program in UTHSC's department of orthopaedics.

"The mission of the council is to develop and implement the state's strategy for battling diabetes and to serve as an advocate for the citizens of Texas," he says. The physicians and podiatrists on the panel are fine-tuning new guidelines, called "algorithms," for diabetes management and prevention statewide. These include recommendations concerning:

· medications for Type 2, or late-onset, diabetes;
· exercise and nutrition modification;
· monitoring of blood lipids, an important indicator of disease.

With important statewide standards in place, the council's task is to spread the word over thousands of miles. "We must reach every health care provider and every patient," says Dr. Harkless, who has conducted community-based studies on diabetic foot care and lower-extremity amputation rates related to the disease. "I believe Gov. Perry appointed me as chair because I understand how to link the disciplines that treat diabetes. We must have a team approach."

The U.S. Centers for Disease Control and Prevention has developed the National Diabetes Education Program, which can be utilized with the Texas program, Dr. Harkless says.

He quoted a fellow team provider who coined the term "diabetes overwhelmus," a play on the proper name of the disease, diabetes mellitus. "Diabetes is a lifelong problem, and patients find it difficult to maintain good self-care. They get tired of the restrictions and the day-to-day grind of trying to be perfect. They need coaching and help. Since diabetes causes damaging complications throughout the body, many health care professionals are involved in its treatment, including eye doctors, kidney experts, endocrinologists, pharmacists and more. The podiatrist, primary care physician, nurse, diabetes specialist and even the shoe seller must work together so that every patient has a chance."

Dr. Harkless is taking the management and prevention algorithms to the state's academic health centers to ensure that students in the various health career tracks are being taught the recommendations. Area health education centers, geriatric extended-care centers, and rural, allied and border health programs emanate from the academic centers.

Gov. Perry announced Dr. Harkless' appointment on May 4. This is the podiatrist's third term on the council and his first as chairman. President George W. Bush, then governor of Texas, selected Dr. Harkless in 1995 and reappointed him in 1998. Dr. Harkless has trained hundreds of doctors of podiatric medicine at the Health Science Center during the last two decades.

The council, which is part of the Texas Department of Health (TDH), will measure the effectiveness of the new standards and the campaign to publicize them. "One way is to see how many diabetics are in the managed care plans," Dr. Harkless said. "We can assess, by looking at records of blood glucose control, how these Texas patients are faring."

The TDH conducts an annual household survey to assess diabetes incidence statewide among adults. In the most recent survey, 911,000 respondents 18 and older reported that a doctor had told them they had diabetes. The disease is especially prevalent in the heavily Hispanic populations of Texas. In Bexar County, which includes San Antonio, more than half of the 62,000 reported cases occurred among Hispanics, according to the TDH.


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