Most medical problems can be cured or fixed, but diabetes isn't one of them. It is a lifelong condition, kept in check by driving down blood glucose to a healthy level and keeping it tightly controlled with a combination of medications that lower blood sugar, proper diet, regular exercise, and other lifestyle changes. A hospital stay due to diabetes-related complications, like nerve pain or circulatory problems, should not happen—it means the disease wasn't properly managed. Moreover, a hospital stay for any reason exposes diabetic patients to special dangers. A patient whose blood sugar is too high has an increased risk of infection and will be slower to heal if surgery is needed.
Maintaining good blood sugar control is particularly challenging in a hospital setting, however. No matter how diligent the care, it won't match the regimen a patient might have meticulously crafted. If a patient is on insulin, the hospital may use a different form—rapid-acting rather than the patient's long-acting version—or administer the wrong dose. (Insulin errors are among the most frequent serious medical mistakes in hospitals.) Meals are likely to be served at different times than a patient is accustomed to, and are not portion-controlled. Blood thinners, blood pressure drugs, pain relievers, and other medications can affect glucose levels. So can the emotional stress of being in the hospital. Moreover, diabetic patients often arrive with other chronic conditions that complicate treatment, such as heart disease and respiratory problems. The 50 diabetes centers ranked in the latest edition of Best Hospitals, released last month by U.S. News & World Report, bring together teams of specialists to deal with these multiple difficulties. The top 10 are shown below, followed by information about what makes a good diabetes center, how to determine whether one is needed, and advice on how to get admitted.
The Best Hospitals in Diabetes & Endocrinology
- Mayo Clinic, Rochester, Minn.
- Massachusetts General Hospital, Boston
- Johns Hopkins Hospital, Baltimore
- University of California, San Francisco Medical Center
- Ronald Reagan UCLA Medical Center, Los Angeles
- Cleveland Clinic
- New York-Presbyterian University Hospital of Columbia and Cornell
- Yale-New Haven Hospital, New Haven, Conn.
- Barnes-Jewish Hospital/Washington University, St. Louis
- Brigham and Women's Hospital, Boston
[See the full list of Best Hospitals in Diabetes & Endocrinology.]
What makes these hospitals the best for diabetes?
Their caregivers are always aware that treating a diabetic patient is complex. They closely monitor blood sugar levels, alert the staff that a patient is diabetic through the use of colorful wrist bands or other means, adjust the timing and content of meals, and take additional special precautions to protect the patient. When a diabetic is admitted because her congestive heart failure is worsening, for example, doctors will check her legs for poor circulation (peripheral artery disease), her stomach for ulcers, her feet for numbness caused by nerve damage, and will be on the lookout for other conditions that may not have revealed themselves but might need attention. Before she is discharged, she will likely be seen not only by diabetologists or endocrinologists but by a team made up of a nutritionist or dietitian, an ophthalmologist, a nurse educator, and other specialists to examine her and help her script a practical plan to deal with her diabetes when she is discharged.
What data were used to reveal these qualities?
Centers at the top of the Best Hospitals rankings had very high reputations among diabetes specialists who responded to U.S. News surveys over the last three years asking where they would send their most difficult diabetes patients if money and geography were not considerations. Almost two-thirds of the physicians, for example, nominated the Mayo Clinic and almost half named Massachusetts General Hospital. Beyond the top 10 hospitals or so, however, reputation wasn't that important. Ten of the 50 ranked hospitals didn't get a single nomination. What put them in the rankings were low death rates (generally at least one-third below the expected rate for patients with serious diabetic conditions and other endocrine disorders after taking into account the patients' condition when they were admitted and other risk factors), strong nursing standards (more than half are "Nurse Magnet" hospitals, formally recognized by the American Nurses Credentialing Center for their high-quality nursing care), and a full roster of patient services that U.S. News has defined as important (such as wound-management services, which are of special significance to diabetics because of skin problems and nerve damage).
How will I know if I need one of these hospitals?
Such a moment might involve a decision that affects your quality of life. About 70,000 diabetics a year, for example, have a foot or leg amputated because of impaired circulation, infection, or other causes. To put it another way, doctors tell nearly 200 diabetic patients on a typical day that amputation is necessary. But the best hospitals for diabetics are less likely to deliver that message. They are more experienced in restoring circulation or at finding other ways to preserve the limb. Top diabetes centers are also better than others at identifying and treating complications before drastic measures like amputation are necessary. Someone whose diabetes is unusually hard to control or whose heart, circulatory, or other diabetes-related complications are progressing might want a consult at a ranked facility within a reasonable distance from home. That shouldn't be overly difficult in most parts of the country. The 50 U.S. News-ranked diabetes hospitals are in 35 different cities across 29 states and the District of Columbia.
Can I get into a ranked hospital?
Almost always. Patients can often do it themselves by calling a patient referral number or sending an E-mail; information on both will be on the hospital's website. You should first check to see if your health insurance carrier will cover the cost. If there is any doubt, your physician should make the referral. He can deal with push back from a health insurer better than you can—he's used to it.