Diabetes Care

Day & Zimmermann, a Philadelphia provider of industrial, defense and workforce services for government and commercial customers, has hired Ken Jobe as vice president, process and industrial, in its engineering, construction and maintenance unit. Jobe was the owner and principal of Polaris Global Solutions.       Intech Construction, a privately held Philadelphia-based construction manager and general contractor, has promoted Joe Kelly, Blaise Lutz, Dave Maguire, and Phil Moses to principals.

Your clothes are a little tighter. You don't remember the last time you went to the gym. You've been reaching for the remote more regularly - and for the chips instead of an apple. You are not looking forward to those blood-test results, either. But the doctor didn't say anything about your weight, so you shouldn't be concerned about it. Right? The reality is that health-care providers and patients often fail to discuss excess weight and obesity when they should. If the American obesity epidemic is going to get better, it's going to have to start with improved communication.

Sweeping spending bills intended to balance the budget by 2002 and change the course of Medicare and other social programs for virtually all Americans were approved yesterday by the House and Senate. "We are going to balance the budget," said House Budget Committee Chairman John R. Kasich (R., Ohio). "The Berlin Wall of big government is going to fall. It's no longer rhetoric, it's reality. " The vote in the House was 270-162, and in the Senate, 73-27. About half the Senate Democrats supported the bill, but only a quarter of House Democrats.

Leaning across a table in his Clifton Heights office, State Rep. Nicholas A. Micozzie explained why he believed his close ties to insurance companies - among his biggest campaign donors - are a boon to his constituents. Suppose a 50-year-old stroke victim called Micozzie, he said, and said insurers were making him leave the hospital too soon. "I call Keystone or Blue Cross," said the 10-term Delaware County Republican, who, as chairman of the House Insurance Committee, knows company executives personally.

Managed-care plans are getting better at ensuring that subscribers get some types of preventive care, while satisfaction with HMOs is remaining relatively stable, the nonprofit organization that accredits many HMOs reported yesterday. The National Committee for Quality Assurance (NCQA) said in a report that New England health plans, on average, outperformed those from all other regions on most clinical performance measures. The Mid-Atlantic region - which includes Pennsylvania, New Jersey and New York - placed second in many cases.

Federal regulators approved a new diabetes drug yesterday with two kinds of beneficiaries: millions of people struggling to control their disease, and the drug giant Merck & Co. Inc. laboring to revive its fortunes. The drug Januvia - a name made up by Merck marketers and meant to convey rejuvenation - is the first approved in a class known as DPP-4 inhibitors. Unlike insulin therapy, the new drugs work by enhancing the body's own ability to lower blood-sugar levels. On Merck's heels, Switzerland-based Novartis AG expects approval soon of its own DPP-4 inhibitor, Galvus, also designed for people with Type 2 diabetes, the most common form.

Jose Santiago was no stranger to the criminal-justice system. He knew the revolving door. When he was arrested on drug charges on North Leithgow Street in North Philadelphia on Sept. 13, he was hauled to a police district headquarters and later transferred to the Police Administration Building. Beyond the shock of arrest and the potential for violence, Santiago had extra reasons to fear what was about to happen. As a type 1 diabetic, he needed to adjust his blood sugar with insulin shots or die. What befell him in the next three days now raises serious questions about the city prisons and exposes taxpayers to yet another lawsuit.

The five elderly patients died terrible deaths in Delaware County nursing homes, prosecutors say. Three had bedsores, one fell into a diabetic coma, and one was fatally scalded. Yesterday, a two-year inquiry into their deaths produced something positive: a set of guidelines that prosecutors hope will become the model for care of diabetics in nursing homes across the nation. While admitting no wrongdoing, the three homes - Chester Care Center in Chester, Bishop Nursing Home in Media, and Manchester House Nursing & Convalescent Center in Media - agreed yesterday to pay a $500,000 penalty and to abide by the new guidelines for diabetes management and basic care.

When 13-year-old Rebeka Abrams fights with her mother, it isn't over typical teenage issues such as dating or curfews. Their battles are over Abrams' diabetes. Abrams' mother suspects Abrams is slack with her medical regimen. Abrams thinks her mother doesn't trust her to manage her disease. "She thinks I'm not taking my insulin or I'm not checking my blood sugar," said Abrams, a seventh grader from Lansford, Pa. "One time she thought my friends were giving me candy and she told my friends if they were giving me candy I wouldn't be allowed to talk with them.

Medicare proposals in this year's balanced-budget deal haven't generated much political heat, but 39 million elderly and disabled beneficiaries still face major changes, including added costs, managed care and some improvements in benefits. Congressional committees plan to begin work on Medicare details shortly after lawmakers return in early June from their recess. Only the outlines of the five-year plan have emerged so far. The bill is shaping up as a combination of President Clinton's proposals and several ideas from the Republican plan he vetoed two years ago. For example, many Republicans want a pilot program to test medical savings accounts in Medicare.