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10/4/2001

Disease Management for Diabetes Ranks High

Cheryl A. Thompson

A national task force on community-based preventive health services has issued a strong recommendation for the use of disease management to optimize the care of patients with diabetes mellitus.

The recommendation is based on an analysis of studies on the effectiveness of various strategies to improve the health outcomes of patients and the behaviors of patients and health care providers.

Seventy studies were found to be worthy of scrutiny by the Task Force on Community Preventive Services, a nonfederal group. Twenty-five of the studies examined disease management, defined as an "organized, proactive, multicomponent approach" to health care delivery.

The hemoglobin A1c level, an indication of glycemic control, decreased by at least 0.5 percentage points in half of the studies that examined this patient outcome as a consequence of disease management. But the programs had inconsistent effects on patients' weight, body mass index, blood pressure, lipid levels, and quality of life.

Disease management resulted in at least 15.6 percent more health care providers monitoring their patients’ level of hemoglobin A1c, the task force found in half of the studies. A median of 24 percent more health care providers monitored lipid levels. Screening of patients for retinopathy, foot lesions, peripheral neuropathy, and urine protein also improved.

Efforts to educate patients in managing their diabetes had mixed results, the task force determined.

Patients who came to libraries and other community-gathering places to learn how to manage their diabetes lowered their hemoglobin A1c level by an estimated 1.9 percentage points. In two of the seven studies analyzed, the patients who attended these educational programs had a lower blood pressure. The programs had inconsistent effects on the patients' level of physical activity, weight, and lipid levels.

Whereas diabetes self-management education programs in community-gathering places earned the recommendation of the task force, albeit only for adults with type 2 diabetes mellitus, similar programs delivered at work sites did not. Only one study of diabetes self-management training at work sites was found.

The task force's recommendations were published in the Recommendations and Reports supplement (PDF) to the Sept. 28 Morbidity and Mortality Weekly Report. A full report will appear next year in the American Journal of Preventive Medicine, the task force said.