In search of ways to improve the way you approach diabetes care in your practice? Consider these strategies, which have worked for us--and have evidence to support them.
PRACTICE RECOMMENDATIONS
* Develop a diabetes registry and use it to identify patients in need of intervention. (B)
* Adopt routine depression screening for patients with diabetes. (A)
* Individualize HbAlc targets based on the patient's comorbidities and duration of diabetes, among other patient factors. (A)
Strength of recommendation (SOR)
(A) Good-quality patient-oriented evidence
(B) Inconsistent or limited-quality patient-oriented evidence
(C) Consensus, usual practice, opinion, disease-oriented evidence, case series
The prevalence of diabetes, particularly type 2 (T2D), continues to grow at an unprecedented rate, (1) largely because Americans are eating more than in years past and exercising less. At the same time, improvements in treatment are resulting in lower rates of cardiovascular (CV) comorbidities and increased longevity for those with T2D. (2,3)
Most patients with diabetes are cared for in a primary care setting. With more than a quarter of those who have diabetes (an estimated 7 million Americans) unaware that they have it, (4,5) primary care physicians typically see many patients with undiagnosed T2D, as well.
Diabetes care is extremely costly; approximately 20 cents of every health care dollar is spent on those with the disease. (6) As a result of this expenditure and increasing adherence to annually updated evidence-based guidelines, (7) control is improving, but slowly: Between 2007 and 2010, only 18.8% of patients with diabetes achieved all 3 American Diabetes Association (ADA) goals-for glycemia, blood pressure, and low-density lipoprotein (LDL) cholesterol. (8)
Part of the problem, experts agree, is that the US health care system is not well suited to manage chronic conditions. This has prompted efforts to develop enhanced delivery modes like the Chronic Care Model and the Patient-Centered Medical Home, (9,10) but none has been widely adopted. While groups that have implemented such changes have had significant success, (11,12) practices already operating at full capacity often find the work of practice transformation to be daunting.
Difficult as the task may be, we've been able to identify--and follow--a number of strategies that serve us well in caring for patients with diabetes. Whether you have the resources to undertake a major practice transformation or simply wish to sharpen your focus, adopting any (or all) of the strategies detailed here will help you optimize diabetes care.
1 Develop a diabetes registry
To have the greatest possible impact on a particular type of patient, you need a way to reliably identify those with a specific condition or set of symptoms. A diabetes registry--a database that starts with basic demographic information for all the patients in your practice with a diabetes diagnosis and is populated with relevant lab results and dates, immunization status, and date of last visit--serves such a function. Some EHRs have this built-in functionality, but most spreadsheet software packages, such as Excel, have the necessary features, as well.
The ideal registry is accurate and up to date, comprehensive, sortable by any of the...