Diabetes Prevention and Control: Disease Management Programs

Disease management is an organized, proactive, multicomponent approach to healthcare delivery for people with a specific disease, such as diabetes. Care is focused on and integrated across the spectrum of the disease and its complications, the prevention of comorbid conditions, and the relevant aspects of the delivery system.

Disease management:

• Identifies all clients or patients affected by the disease
• Determines the most effective ways to treat the disease

Summary of Task Force Recommendations & Findings

The Community Preventive Services Task Force recommends diabetes disease management on the basis of strong evidence of effectiveness in improving:

• Glycemic control
• Provider monitoring of glycated hemoglobin (GHb)
• Screening for diabetic retinopathy

Sufficient evidence is also available of its effectiveness in improving:

• Provider screening of the lower extremities for neuropathy and vascular changes
• Urine screening for protein
• Monitoring of lipid concentrations

Although a number of other important health outcomes were examined, including blood pressure and lipid concentrations, data are insufficient to make recommendations based on these outcomes.

Task Force Finding

Results from the Systematic Reviews

Twenty-seven studies qualified for the review.

• Glycated hemoglobin (GHb) levels: 0.5 percentage point median decrease (interquartile interval: 1.4% to 0.1%; 19 studies)
• Monitoring by healthcare providers improved for several diabetes-related conditions:
  • GHb levels: median net increase of 15.6% (interquartile interval: 4 to 39%; 15 studies)
  • Lipid concentrations: median increase of 24.0% (interquartile interval: 21 to 26%; 9 studies)
  • Retinopathy: median increase of 9.0% (interquartile interval: 3 to 20%;15 studies)
  • Urine protein: median increase of 9.7% (interquartile interval: 0 to 47%; 7 studies)
  • Foot lesions and peripheral neuropathy: median increase of 26.5% (interquartile interval: 11 to 54%; 9 studies)
• Findings can be applied to people with either type 1 or type 2 diabetes treated in both community clinics and managed care organizations. It is not clear how well these findings apply to treatment in other settings.

Review of Economic Findings

Two economic studies were included in this review.

• The first study, conducted in Scotland, reported the average cost for adult patients of an integrated care disease management intervention versus traditional hospital clinic care.
  • Annual average adjusted costs were $143 to $185 for integrated care and $101 for traditional care, resulting in a higher annual average cost for the intervention of $42 to $84.
  • After two years no significant difference was seen between the two groups for GHb, body mass index, creatinine, or blood pressure.
  • Integrated care patients had higher annual rates compared with the traditional care group for routine diabetes care visits (5.3 versus 4.8) and screening and monitoring of GHb (4.5 versus 1.3), blood pressure (4.2 versus 1.2), and visual acuity (2.6 versus 0.7).
• The second study was a cost–benefit analysis of preconception plus prenatal care versus prenatal care only for women with established diabetes. No effect size was determined, as this was a modeling study relying on secondary data.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to diabetes control.

Supporting Materials

• Analytic frameworks [PDF - 379KB]
• Research gaps
• Included studies

Publications

Norris SL, Nichols PJ, Caspersen CJ, et al. The effectiveness of disease and case management for people with diabetes: a systematic review. [PDF - 784KB] Am J Prev Med 2002;22(4S):15-38.

Task Force on Community Preventive Services. Recommendations for healthcare system and self-management education interventions to reduce morbidity and mortality from diabetes. [PDF - 67KB] Am J Prev Med 2002;22(4S):10-4.

Task Force on Community Preventive Services. Strategies for reducing morbidity and mortality from diabetes through health-care system interventions and diabetes self-management education in community settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2001 ;50(RR16):1-15.

Task Force on Community Preventive Services. Diabetes. [PDF - 331KB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:188-222.

More Community Guide publications about Diabetes Prevention and Control

---



Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Diabetes prevention and control: disease management programs www.thecommunityguide.org/diabetes/diseasemgmt.html. Last updated: MM/DD/YYYY.

Review completed: December 2000