What We Want to Achieve Through Systems Changes

Clinical Management

The BetterDiabetesCare website is designed to address elements that affect the delivery of quality diabetes care. Evidence-based decision-making and patient-centered care – two particularly important elements that help improve clinical care for patients with or at risk for diabetes – have been covered in previous sections. Clinical management of diabetes is addressed by many professional organizations and publications. The clinical resources listed in alphabetical order below, therefore, only reflect those related to the National Diabetes Education Program (NDEP).

Business Health Strategy Resources

Diabetes Numbers at-a-Glance Reference Card

Foot Care Guide

Glomerular Filtration Rate Calculators

Guiding Principles for Diabetes Care

Office Posters

Small Steps Big Rewards - Prevent Type 2 Diabetes

Slide Presentations

Support Behavior Change

Team Care Guide

Transitions from Pediatric to Adult Health Care

Working Together to Manage Diabetes: A Guide for Pharmacists, Podiatrists, Optometrists, and Dental Professionals

Working Together to Manage Diabetes: Diabetes Medications Supplement

Some of the Major National Surveys and Clinical Research Studies – Published or In Progress – that Inform the NDEP

NATIONAL SURVEYS

The Centers for Disease Control and Prevention (CDC) sponsors major national surveys that track health status and health care delivery including the National Health Interview Survey, the National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Survey Study.
 

PUBLISHED CLINICAL RESEARCH – in alphabetical order

Actions to Control Cardiovascular Risk in Diabetes (ACCORD)

Gerstein HC, Miller ME, Byington RP, et al.: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545-59.

The ACCORD Study Group: Effects of Intensive Blood-Pressure Control in Type 2 Diabetes Mellitus. N Engl J Med 2010.

The ACCORD Study Group: Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus. N Engl J Med 2010.

Action in Diabetes and Vascular Disease: PreterAx and DiamicroN MR Controlled Evaluation (ADVANCE)

Patel A, MacMahon S, Chalmers J, et al.: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358(24): 2560-72. content.nejm.org/cgi/reprint/358/24/2560.pdf

Diabetes Prevention Program (DPP)

Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6): 393-403.

Knowler WC, Fowler SE, Hamman RF, et al.: 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374(9702): 1677-86.

Diabetes Control and Complications Trial (DCCT)

Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993; 329(14): 977-86.

Nathan DM, Cleary PA, Backlund JY, et al.: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353(25): 2643-53.

United Kingdom Prospective Diabetes Study (UKPDS)

UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352(9131): 837-53.

UK Prospective Diabetes Study (UKPDS) Group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352(9131): 854-65.

UK Prospective Diabetes Study (UKPDS) Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317(7160): 703-13.

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA: 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. N Engl J Med 2008; 359(15): 1577-89.

Veterans Affairs Diabetes Trial (VATD)

Duckworth W, Abraira C, Moritz T, et al.: Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360(2): 129-39.
 

STUDIES IN PROGRESS – in alphabetical order

DirecNet Diabetes Research in Children Network (DirecNet) is a network of clinical centers conducting research on the potential use of continuous glucose monitors and their impact on the management of type 1 diabetes in children.

HEALTHY was conducted in 42 middle schools randomized to intervention or control groups. A multi-disciplinary effort was designed to change the school nutrition environment, related to food and beverage quality and availability, and the physical activity environment, related to physical education class activities and involvement. Educational and promotional programs and campaigns targeted healthy behaviors and awareness. A cohort of students was recruited in 6th grade and followed through the end of 8th grade. Six pilot and feasibility studies were conducted prior to the full scale trial. The first results from the trial are due 2010.

Look AHEAD Action for Health in Diabetes is a multicenter randomized clinical trial to examine the effects of a lifestyle intervention to achieve and maintain weight loss over the long term through decreased caloric intake and exercise. The trial completed enrollment of 5,145 obese patients with type 2 diabetes in 2009. At study entry, participants were randomly assigned to one of two interventions, the Lifestyle Intervention or Diabetes Support and Education. They will be followed for up to 11.5 years.

TEDDY The Environmental Determinants of Diabetes in the Young - is an international study in six clinical centers looking for the causes of type 1 diabetes mellitus (T1DM). The study will identify infectious agents, dietary factors, or other environmental agents, including psychosocial factors which trigger T1DM in genetically susceptible individuals or which protect against the disease.

TODAY STUDY Treatment Options for type 2 Diabetes in Adolescents and Youth is a multi-center clinical research study. It is examining the safety and efficacy of three treatments involving intensive lifestyle intervention and medication therapy for type 2 diabetes in the pediatric population. TODAY has enrolled 750 children, age 10-17, at 13 sites around the United States, and will follow them for two to five years. Enrollment ended in 2009.

TrialNet Type 1 Diabetes TrialNet is an international consortium working to advance the science of prevention and early treatment to preserve residual insulin secretion in type 1 diabetes. A clinical trial network of researchers in the United States, Canada, United Kingdom, Europe, Australia, and New Zealand are involved in designing clinical trials to test new ways to prevent type 1 diabetes and to preserve beta cell function in people who already have type 1 diabetes.

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