Diabetes Dateline
Fall 2008

Organizations Test Collaborative Models for Diabetes Self-management

Managing diabetes is a big job—one that falls primarily on those who have the disease. The more people with diabetes learn about how to manage their illness the better. Research shows self-management of diabetes saves money and improves care.

A unique program with the goal of promoting diabetes self-management is so far yielding positive results. The employer-based program builds on National Diabetes Education Program (NDEP) messages about diabetes and how people can be self-managers of their care, William Ellis, R.Ph., M.S., CEO of the American Pharmacists Association (APhA) Foundation, told attendees at the spring NDEP Steering Committee Meeting.

Through the Diabetes Ten City Challenge, employers create a voluntary health benefit for employees, dependents, and retirees with diabetes and waive copayments for diabetes medicines and supplies if they work with a pharmacist coach, along with their doctors and diabetes educators, to manage their condition.

Participating pharmacists, who are specially trained in diabetes care, meet with program participants regularly to track key diabetes indicators and discuss medications, diet, nutrition, and physical activity. Employers pay pharmacists for the care they provide. Since the program’s inception in October 2005, 31 employers in 10 cities have partnered with hundreds of pharmacists to help more than 1,000 people with diabetes manage their disease.

Positive Outcomes

Initial data published in the March issue of the Journal of the American Pharmacists Association show improvements across all key clinical and patient satisfaction indicators, including

• decreases in laboratory measures for A1C, LDL cholesterol, and blood pressure during the first year of the program
• increases in the number of participants with current flu vaccinations and foot and eye examinations
• a 21 percent increase in the number of participants achieving the American Diabetes Association goal of A1C levels below 7
• an increase in the number of participants setting self-management goals to control their diabetes, including nutrition, weight, and physical activity goals
• an increase—from 39 percent to 87 percent—in the number of participants who said their overall diabetes care was “very good to excellent”

“The results to date prove that this collaborative practice model is effective for managing diabetes and replicable in diverse locations and employers,” Ellis said. “In years of experience with this model, we have seen that when you have positive clinical outcomes and increased patient satisfaction in the early stages, the economic benefits follow.”

Ellis also said HealthMapRx, an initiative announced by the APhA in 2007, offers the collaborative practice model to employers throughout the United States to help manage diabetes and other chronic illnesses such as depression, cardiovascular disease, and asthma.

Collaborative Learning

Carole A. Brownson, M.S.P.H., deputy director of the Diabetes Initiative at the Robert Wood Johnson Foundation (RWJF), agreed that an organizational commitment to self-management is needed for successful diabetes control. The RWJF Diabetes Initiative successfully implemented programs in 14 primary care and community sites across the United States using a collaborative learning network model, Brownson told meeting participants. “Resources and supports for self-management are key to good diabetes care,” said Brownson.

• improving self-management supports through organizational and program improvements in primary care settings
• improving diabetes care and self-management through innovative community/clinic partnerships aimed at demonstrating the value of community support for diabetes care and coordinating clinic and community-based services

The initiative also worked with four sites on pilot projects aimed at making policy and environmental changes in communities and schools to prevent diabetes by reducing the risk of obesity among children ages 3 to 12.

The initiative has made materials for project implementation, training, education, and assessment available for others to use on its website at www.diabetesinitiative.org. To learn more about the Diabetes Ten City Challenge, visit www.diabetestencitychallenge.com. For more information about the NDEP, go to www.ndep.nih.gov; type in “diabetes self-management” for NDEP information about this topic.

The National Diabetes Information Clearinghouse has an easy-to-read booklet called Prevent diabetes problems: Keep your diabetes under control. The booklet is part of a series of publications to help people prevent diabetes complications through self-management of their disease. These publications are available at www.catalog.niddk.nih.gov/PubType.cfm?Type=167&CH=NDIC.

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NIH Publication No. 09–4562
December 2009