Friday, August 19, 2011

Diabetes care redesign recommendations ready to be implemented

David Nathan, MD, director of the
Diabetes Center at MGH and co-chair
of the Partners Diabetes Redesign

Teams of experts from the MGH and other Partners affiliates are focusing on improving patient care, and an initial group of five teams has developed recommendations for colon cancer; coronary disease; specifically acute myocardial infarction and coronary artery bypass graft surgery; diabetes; primary care; and stroke. In May, the recommendations were reviewed and approved by leadership, and the teams now are moving forward with implementation. This is the first in a series of articles MGH Hotline will publish detailing the efforts of several of these teams. 

Centers for Disease Control and Prevention (CDC) data indicate that nearly 26 million people in the U.S. are affected by diabetes. David Nathan, MD, director of the Diabetes Center at MGH and co-chair of the Partners Diabetes Redesign Initiative, describes diabetes as a major chronic health issue that differs from other acute conditions like heart attacks, strokes and colon cancer. Diabetes care is provided by many health care professionals, which makes redesign challenging but needed. Direct and indirect costs of the disease combined hover around $200 billion a year.

“Diabetes is the most common cause of blindness, kidney failure and amputations and increases the risk for heart disease by two to five fold,” says Nathan. “The management of blood glucose, blood pressure and lipid levels reduces the risk of developing these long-term complications, including cardiovascular disease, but the challenge is to maintain, or even improve our care, at lower cost,” he added.

The Partners Diabetes Redesign Team has offered a number of recommendations, approved by Partners leadership. The recommendations are aimed at improving care for patients with type 2 diabetes, the most common form, but at lower cost. During the next three months, Nathan’s team and physicians, nurses and other diabetes leaders at Partners institutions will start implementing three major recommendations. In an effort to reduce co-pays, less expensive generic medications will be recommended for patients to treat their diabetes, hypertension and abnormal lipids (risk factors for the eye, kidney, nervous system and cardiovascular disease complications). In addition, Nathan says for patients who are treated with insulin, the only oral agent that is usually necessary is metformin, one of the oldest and least expensive diabetes medications. His team will suggest that health care providers transition type 2 diabetic patients on insulin plus metformin off other oral agents, which should lower pharmaceutical costs. Lastly, he says patients who are unable to achieve glycemic (glucose) control on more than two oral agents should be transitioned to insulin use, which should improve their glucose control and improve long-term health.

As the recommendations are put into effect, and more research is done – much of it at the MGH Diabetes Center – Nathan is optimistic managing diabetes will become easier and less expensive. 

“The good news is that we now have the means of decreasing the development of type 2 diabetes and understand how to reduce its long-term complications substantially,” says Nathan.

For more information about the Partners Strategic Initiative and the other care redesign teams, access

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