3 best practices for both physicians and patients to treat diabetes

As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.

With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based research network composed of primary care providers in North Dakota and led by Charles Christianson, MD, joined together with The Physicians Foundation, a nonprofit national organization dedicated to improving the quality of healthcare for all Americans and advancing the work of practicing physicians.

The two groups conducted a study that examined which practice interventions used by physicians and other healthcare providers in North Dakota clinics produced better compliance with recommendations for diabetes care. This research resulted from a $370,000 Physicians Foundation grant awarded to establish NORTHSTAR, which is part of the University of North Dakota.

Tracking patient compliance is critically important for effective patient treatment because it enables physicians to see if patients are attending office visits and receiving lipid-level tests, annual eye examinations, and other recommended care.

In the study, researchers surveyed 425 primary care physicians in order to understand which diabetes interventions were available and utilized within North Dakota clinics. They compared the respondents’ results to an aggregated summary of provider data given to them by Blue Cross Blue Shield of North Dakota.

The insurers’ information included the number of diabetic patients assigned to each physician and their adherence to five clinical guidelines: annual office visits, hemoglobin A1c tests, eye exams, lipid tests, and microalbumin tests, as well as a general “all five categories met” measure.

The study, titled “Diabetes Care Interventions: A Best Practices Study,” revealed three best practices for both physicians and patients to utilize in ongoing diabetic treatments:

Use of a diabetes patient registry. The numbers of patients who require treatment for diabetes far exceed the supply of doctors, which, consequently, puts considerable strain on health providers to maintain accurate records and information. Additionally, factors such as unforeseen medical changes and individuals switching providers can impact treatment consistency, continuity, and effectiveness. Therefore, it is paramount to use tools such as a diabetic patient registry to document patient information accurately and effectively.

By employing a diabetic patient registry, physicians and health providers can track a number of interventions and understand a patient’s overall medical history better. The registry also can alert doctors about patient compliance issues or problems that affect treatment timing. Examples include scheduling blood tests to measure hemoglobin A1c (HbA1c)/lipid/microalbumin levels and making certain patients are complying with treatment regimens.

Patient performance reporting and feedback tools. Treatment measures for diabetic patients are diverse and wide-ranging. Patient conditions constantly change and require clinicians to adjust treatments to reflect these developments. Instituting a comprehensive reporting and feedback system helps to mitigate errors and fosters a higher level of quality of patient care.

Additionally, such a system enables physicians to prioritize interventions that are most effective in patient care because they have access to up-to-date treatment information. As a result, clinicians can actively monitor and adjust patient treatments to maximize the possibility of healthy outcomes. Both of these interventions can be made with paper records, but are more easily implemented with electronic health records.

Use of a dietitian. Individuals with diabetes are confronted with issues that impact both their diet and exercise. Beyond conventional medical treatments, diabetic patients can greatly benefit from working with a dietitian to advise them on a balanced approach that combines healthy eating and appropriate exercise programs.

Importantly, dietitian encourage patients to take a more active role in monitoring their diabetes. This leads to regular compliance with office visits and having their HbA1c and lipid levels tested as needed. This active approach not only allows patients to address diabetes physically, but also provides a sense of individual empowerment.

Collectively, these three practices greatly enhance the treatment of diabetes. Physicians are better positioned — through reporting/feedback tools and an accurate diabetic registry — to support patients in a pragmatic and effective manner. Patients also benefit from the physical health advantages of a dietitian and the psychological empowerment of knowing they can actively combat diabetes.

Although this study was conducted in North Dakota, the findings can be applied to practices across the U.S. Diabetes continues to be a deadly and financially costly disease. However, the advancement of effective treatments and continued research provides us with tremendous hope and optimism for the future.

Alan L. Plummer is the vice president of The Physicians Foundation and a professor of medicine at Emory University.

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  • Chris OhMD

    This concept applies to chronic disease mgmt in general. Diabetes probably requires the most amount data  in terms of both input and analysis because blood sugars can fluctuate widely during a single day as opposed to CHF where you are tracking daily Wts. I think the challenge will be getting the patients and MDs to participate. It’s one thing to have a tool, it’s another to actually use it.

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    I would like to know more about which feedback systems have proven effective and not too costly for the patient.

  • Anonymous

    Can anyone add some info to diabetes treatment?

  • http://www.facebook.com/profile.php?id=1311249696 Tanya Woldbeck Gesek

    I think this best practice list also needs to acknowledge that compliance with any regime is complicated by mental health and lifestyle choice issues.  I think any comprehensive treatment plan needs to screen for possible depression or other psychological factors that impact a patient’s compliance with recommendations.  Psychologists need to be a part of this dialogue in improving health care outcomes!

  • Anonymous

    One thing that is really a problem is that there are at least 20 different blood glucose meters on the market with 20 different types of test strips. Some folks say we don’t need the federal government messing with how health care is delivered? Well, here’s a case where federal government leadership is needed to lower the costs of diabetes treatment. If government would simply set a generic standard for test strips so that they are interchangeable among all of the many blood glucose meters, the cost of test strips would be lowered overnight! Nobody in the industry wants to be the leader because they make huge profits in the current status quo chaos while consumers continue to pay more and more for these simple tests. Will there ever be a time when the industry puts the consumer first instead of their stock holders? Private enterprise is killing our health care system!

  • Anonymous

    Talk about a chaotic health care system, when a diabetic orders insulin pens, the pharmacy “never” includes the pen needles. It’s like they know you can’t get the insulin out of the pen unless you have a needle but they act stupid and let you suffer while telling you that you need to pay more money if you want to get the insulin out of the device. They make the excuse that there are different size needles. So, how hard is it to ask what size needles are needed and include the needles in one single script? So, insulin dependent diabetics need “two” scripts when they get insulin pens. One for the pens and one for the needles. How stupid is that? And people say they don’t want the federal government to regulate health care? If the federal government doesn’t show leadership, who will? The doctors? Fat chance! The hospitals? Fat chance! The drug makers? Fat chance! They have never shown leadership before, why would they start showing leadership now? Only the federal government can figure out that insulin pens won’t work without pen needles. Why? Because maybe the private health care industry is too dumb to do it themselves. Either that, or they are making huge profits by keeping insulin and needles separate. My guess, it’s the latter! Meanwhile, the consumer continues to pay more and suffer more!

  • Anonymous

    Another problem for diabetics… Some diabetics need adjustments to their medications on a weekly or monthly basis until they get “regulated”. Seeing the doctor that frequently costs a fortune just in the cost of the visit, let alone the cost of the medications. It would be nice to use email to contact the doctor for these adjustments. Do you think doctors would agree to that? Not a chance! In fee-for-service health care, doctors only make money when you visit them in person. They will blame it on the fact that they can’t take the risk of not seeing the patient before they prescribe new medications. So, diabetics have a choice. Usually the choice comes down to affordability. They simply don’t go. They wait. The wait usually worsens the condition. The fee-for service model isn’t working. We need a different delivery model. We need a model where we use technology more and doctors less. Normally, a nurse can do the job of maintaining and regulating a diabetic in a clinical setting. We need to stop using doctors for every little thing. Diabetes maintenance, in most cases, isn’t rocket science. Maybe we need regional clinics “just for diabetes” where nurses and technicians perform the routine maintenance of diabetic patients. The current fee-for-service delivery model is broken beyond repair and way too expensive. It needs to be changed! Completely overhauled!

  • http://twitter.com/DrDanSindelar Dr. Dan Sindelar

    Diabetes is also bi-directionally linked to periodontal disease. I’m a dentist, and I’ve found that eliminating gum disease in my patients can not only help their numbers but also reduce the risk for diabetic complications. This means that their overall healthcare costs go down as well. Just food for thought!

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