July 30, 2001People with type 2 diabetes experience fewer complications and require fewer hospitalizations when managed by a team of health care professionals rather than a primary care provider alone, researchers concluded in a new report by the National Diabetes Education Program (NDEP). The NDEP is a collaboration between the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH).
In the report, Team Care: Comprehensive Lifetime Management for Diabetes, the nation’s foremost diabetes experts jointly call on decisionmakers at managed care organizations and purchasers of health care plans to adopt a team approach. This includes integrating the skills of different health care professionals to offer people with diabetes continuous, supportive, and aggressive care throughout the course of their disease.
Team care integrates the skills of different health care professionals with those of the patient and family into a comprehensive, lifetime, diabetes management program. There is unequivocal evidence that the human and economic toll of diabetes can be significantly reduced by early, aggressive, and ongoing intervention. The Team Care report provides an analysis of that evidence and supports using a multidisciplinary team as an effective method to manage diabetes as a chronic disease.
"Diabetes is a chronic disease that cannot be managed successfully with sporadic, reactive, or after-the-fact care. If diabetes care is to achieve the health benefits that modern science has made possible, it must be continuous, proactive, and planned," said Dr. Charles Clark of the Indiana University School of Medicine, who is also NDEP steering committee chair.
The total cost of caring for diabetes in the United States in 1997 was $98.2 billion. People with diabetes accounted for up to 15 percent of total U.S. health care expenditures and 27 percent of all Medicare expenditures. Studies show that the team approach results in a reduction of these costs, thanks to shorter hospital stays, fewer hospital readmissions, and reductions in disabilities and associated costs. For example, in one study the average length of stay for patients with a primary diagnosis of diabetes was 56 percent shorter for team-managed patients compared to patients managed by an internist alone.
"Healthcare policy makers and payers have strong incentives to support any care improvements to help prevent or delay costly diabetes complications," said Clark. "Coordinated, multidisciplinary team care provides a high-quality, cost-effective method for improving patient control of their disease and reducing health care costs."
Type 1 diabetes, previously called juvenile-onset diabetes, may account for between 5 percent and 10 percent of all diagnosed cases of diabetes. Autoimmune, genetic, and environmental factors are involved in its development. Type 2 diabetes, previously called adult-onset diabetes, may account for about 90 percent to 95 percent of all diagnosed cases of diabetes. Risk factors include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and racial or ethnic group.
The report also offers practical, how-to advice for decisionmakers on implementing a team care approach in any health care setting, whether a centralized facility or a decentralized health system. Team Care: Comprehensive Lifetime Management for Diabetes is available on NDEP’s Web site at http://ndep.nih.gov and a free copy is available by calling the NDEP at (800) 438-5383. For more NDEP information, you can also visit CDC’s Web site at http://www.cdc.gov/diabetes.
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