Measuring Outcomes of Type 2 Diabetes
Background. There is a need to evaluate empirical disease management programs used in managing chronic diseases such as diabetes mellitus in managed care settings.
Methods. We analyzed data from 252 patients with type 2 diabetes before and 1 year after enrollment in a disease management program. We examined clinical indicators such as HbA1C, HDL, LDL, total cholesterol, diastolic blood pressure, and BMI in addition to self-reported health status measured by SF-36 instrument.
Results. All clinical indicators showed statistically and clinically significant improvements. Only vitality and mental health showed statistically significant improvements in health status. Weak to moderate significant correlation between clinical indicators and health status was observed.
Conclusions. Disease management can be effective at making significant clinical improvements for participants in a mixed-model HMO setting. No strong relationship between clinical indicators and health status was found. Future research is needed using a more specific health status measuring instrument and a randomized clinical trial design.
According to the Centers for Disease Control and Prevention, 15.7 million people in the United States are afflicted with diabetes. It is estimated that patients with type 2 diabetes mellitus account for 90% to 95% of those with the disease. Patients with diabetes have a high risk of experiencing complications such as retinopathy, nephropathy (including end-stage renal disease), lower extremity amputations, coronary artery disease, and cardiovascular disease. The underlying mechanisms of these complications are known to be microvascular and macrovascular changes. Most complications are preventable, but they often are not manifested for many years after the initial diagnosis of diabetes. A key strategy for minimizing complications is metabolic control through a combination of diet, exercise, and medication. Management of diabetes requires not only metabolic control but also reductions in cardiac risk factors; fortunately, compatible strategies can be used to obtain both of these goals. To prevent complications, disease management programs seek sustained life-style changes. Assessment of program effectiveness should include measurements of both metabolic control and cardiac risk factor reductions.
Many studies have shown the effectiveness of blood glucose control. The use of multidisciplinary teams for such purposes is advocated, and structured programs using a combination physicians and non-physicians have been shown to yield better results in metabolic control than traditional care through primary care physicians alone.
One of the challenges of disease management for chronic diseases such as diabetes, hypertension, and hyperlipidemia is that patients often do not perceive, at least in the short term, the untoward effects of these diseases, so improvements in clinical measurements do not always translate into patients immediately feeling better. In addition, patients may not perceive many of the life-style modifications required for the management of diabetes (such as dietary restrictions and exercise) as desirable, and this can negatively affect compliance. Assessment of patient perception of health-related quality of life (HRQOL) is an important component in evaluating the effectiveness of disease management programs. Diabetes management would be beneficial not only in improving short-term HRQOL, but also in reinforcing patient compliance with long-term life-style changes.