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CDC COMMUNITY GUIDE: Diabetes Prevention and Control: Disease Management Programs

CDC

An Evidence-Based Practice

Description

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 co-morbid 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

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

Impact

The Diabetes Community Guide can improve biological components of diabetes for those treated for either type 1 or type 2 diabetes in both community clinics and managed care organizations.

Results / Accomplishments

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.

About this Promising Practice

Organization(s)
Community Guide Branch Epidemiology and Analysis Program Office, Centers for Disease Control and Prevention
Primary Contact
The Community Guide
1600 Clifton Rd, NE
MS E69
Atlanta, GA 30329
404-498-1827
communityguide@cdc.gov
https://www.thecommunityguide.org/topic/diabetes
Topics
Health / Diabetes
Organization(s)
Community Guide Branch Epidemiology and Analysis Program Office, Centers for Disease Control and Prevention
Source
Community Guide Branch Epidemiology and Analysis Program Office, Centers for Disease Control and Prevention
Location
USA
For more details
https://www.thecommunityguide.org/
https://www.thecommunityguide.org/topic/diabetes

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.
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