Diabetes is a complex disease often accompanied by co-morbidities such as nerve, eye, kidney and cardiovascular disease. Medical standards of care for diabetes address not only management of the disease, but screening for and managing related complications such as cardiovascular disease. Physicians need to work closely with other specialists and ancillary care professionals such as vision care and foot care providers to provide comprehensive diabetes care. Diabetes organizations recommend that physicians adopt a “team approach” to treating diabetes, one that includes working with diabetes educators, specialty clinicians, and others to provide information, motivation and support to promote effective patient self management.
Web based resources on standards of care for diabetes can be found from several medical specialties. The American Diabetes Association has adopted widely used standards for care:
ADA “Executive Summary Standards of Medical Care in Diabetes - 2008”
http://care.diabetesjournals.org/cgi/reprint/31/Supplement_1/S5.pdf
Points to make with physicians:
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Standards of care have a number of key, common elements including:
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Testing for Hemoglobin A1C (A1C)
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Dietary management, including low fat and low carbohydrate meals
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“medical nutrition therapy” by trained providers to educate patients on dietary requirements
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Encouraging aerobic exercise and resistance training
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Monitoring blood pressure and lipid levels
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Screening for kidney and retinal disease
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Examining feet for signs of nerve disease
- Delivering preventive services, including immunizations, smoking cessation, and depression screening
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Managing diabetes and its complications is not simple; physicians may not know what services are needed unless they have tools to support them. Physicians need office protocols to track diabetic patients and the services they need. These systems could include electronic health records, flow charts, or patient registries. Many simple tools are referenced in this toolkit.
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Physician services must be coordinated with other providers and systems established for documenting in a central location that essential care was delivered. Payers are tracking quality of diabetes care through HEDIS indicators and other performance measures and are reporting results to employer/purchasers.
- Where a disease management program is offered, physicians should be encouraged to refer patients for disease management and request documentation back from disease management
PPOs can identify and link providers with other resources to promote quality care. Many communities have local resources for patients, including free or low cost programs for diabetes support and education. Payers and PPOs can help to connect patients to these services through web based information or care management referrals and ideally can track services through information technology.
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Copyright AAPPO April, 2008
