Skip to main content
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Spectrum

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Spectrum
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
Departments

The Role of Disease Management in Diabetes Care

  1. Gretchen Benson, RD, LD, CDE
Diabetes Spectrum 2010 Mar; 23(2): 116-118. https://doi.org/10.2337/diaspect.23.2.116
PreviousNext
  • Article
  • Info & Metrics
  • PDF
Loading

Approximately 16,600 health care professionals hold the title of certified diabetes educator (CDE).1 With > 24 million people living with diabetes in the United States,2 this translates into roughly one CDE for every 1,500 individuals with diabetes.

Because of the chronic nature of diabetes and its associated complications, diabetes requires constant attention and regular follow-up. It is well documented that keeping blood glucose and blood pressure levels at near-normal levels significantly reduces diabetes-related complications.3,4 According to National Health and Nutrition Examination Survey data, the age-adjusted percentage of people achieving glycemic, blood pressure, and cholesterol targets (i.e., all three targets) increased from 7.0% in the period from 1999 to 2002 to 12.2% in the period between 2003 and 2006.5 Although the proportion of those achieving these three targets appears to be increasing, there remains a significant proportion of individuals with diabetes who fail to achieve recommended A1C, blood pressure, and cholesterol levels.

Given the rapid rise of diabetes during the past several decades and the immense opportunity to improve diabetes-related measures, the need for health care professionals with diabetes expertise is crucial to improve the health of the population. In addition to specialized educator availability, other barriers that may limit the amount of preventive or follow-up care patients receive include cost of care, access to care (e.g., because of rural location or lack of transportation), appointment-scheduling constraints, time away from work, and low level of education.6

Disease management may be able to bridge some of this gap. In fact, a growing number of health plans are trying to manage their diabetes population through in-house disease management programs, with the intent of improving health outcomes and reducing the population's risk of developing serious long-term complications. Although health plans are a major adopter of disease management programs, other sources for disease management include employers, private companies, and hospital- and community-based clinics.

Key reasons identified for adopting disease management programs include improving clinical outcomes, reducing medical costs and utilization, and improving member satisfaction.7 The specific goals of a particular disease management program may vary, but in the broadest sense, disease management programs provide patient education and support by using evidence-based practice guidelines to prevent complications and improve patients' overall health. This, in turn, reduces unnecessary health care utilization, driving down costs.

Disease management first became known in the late 1980s, with more widespread implementation occurring in the mid- to late 1990s. Because there was no recognized governing body for such efforts, programs were designed with varying features, and there was very little consistency among the programs.8

To remedy this problem, the Disease Management Association of America (DMAA), a nonprofit trade association representing stakeholders in the disease management industry, created a definition for disease management and defined core program components. The DMAA defined disease management as “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.”9 To be classified as a disease management program, the program must implement six core components. These include population identification, collaborative practice models to include physicians and support service providers, patient self-management education, process and outcomes measurement, evaluation and management, and routine reporting.9

Aside from the core components, other features of the interventions offered through disease management programs, including educational content, intensity/duration/frequency of the program, and delivery mode (e.g., face-to-face vs. telephone, mail, or Internet-based) vary greatly. Additionally, some programs are described as “opt-in,” in which individuals actively decide to participate, whereas others use an “opt-out” model, in which all individuals are counted as “in” the program unless they proactively contact the program to state that they do not want to participate.

Regardless of their particular design, disease management programs have the opportunity to reach patients at a “teachable moment,” perhaps through a live referral or after a significant event, such as a disease-related hospitalization or a new diagnosis. Telephone-based programs are able to mitigate some of the previously noted barriers to care, such as inaccessibility, inconvenience, and high costs.

Typically, nurses have facilitated disease management interventions; however, as disease management evolves, those in the field are recognizing the importance of a multidisciplinary approach. Professionals providing disease management services may include nurses, registered dietitians, social workers, pharmacists, or physical therapists.8

Programs may incorporate education and counseling techniques such as motivational interviewing and facilitation of patient self-management. This type of approach usually involves having individuals with diabetes setting goals, with guidance as needed from their health professional or “disease manager.” In subsequent encounters, providers and patients revisit the goals and discuss next steps of future goals.

Health care providers also address preventive service reminders (e.g., to get a foot exam, flu and pneumonia vaccines, a dental exam, or a retinal eye exam) and clinical guidelines (e.g., for checking A1C, blood pressure, and cholesterol levels) during patient encounters.

Some disease management programs allow disease managers to make independent medication adjustments, usually with predetermined protocols. As expected, patients who are able to adjust medications with the help of their disease manager are able to get closer to goal than patients who do not have such a service.10,11 Referrals back to patients' primary care provider or other diabetes care team members (e.g., diabetes nurse, registered dietitian, and pharmacist) are made for routine follow-up appointments or for times when a need arises (e.g., when a patient is taking medication incorrectly or experiences adverse side effects or complications).

Of crucial importance to the success of disease management interventions is the link back to patients' diabetes care team. Disease management is often referred to as “between-visit care,” because it provides education and support that reinforces the messages patients receive from their primary care provider and clinic-based diabetes care team. Providing consistency and reinforcement of such messages allows for more patient buy in and illustrates that all parties are collaborating for the best interests of patients, enhanced patient care services, and better health outcomes.

Systematic reviews have looked at the impact of disease management programs on diabetes care.12,13 The results show modest improvements in glycemic control and improved screening rates. A study of > 500 patients found that intensive telephone follow-up resulted in better adherence to preventive measures recommended by the American Diabetes Association, including annual eye exams, professional foot exams, foot self-exams, and pneumonia vaccinations.14 A health plan–based disease management program demonstrated that program participants achieved lower A1C levels and better adherence to A1C testing recommendations than nonparticipants and had fewer hospitalizations and emergency room visits, resulting in cost savings.15 A study of patients who receive care through the U.S. Department of Veterans Affairs patients found that automated disease management calls coupled with live telephone-based nurse follow-up care resulted in improved A1C levels, fewer reported symptoms of poor glycemic control, and higher rates of specialty care utilization.16

The sparse use of electronic medical records (and lack of consistency among them) can pose a barrier to truly integrated care. Additionally, it is difficult to compare and contrast independent disease management programs because of the high degree of variation in program designs. Despite these problems, current research shows that disease management can have a positive impact on the health of people with diabetes.

As disease management programs continue to evolve and expand, more research will be needed to determine their long-term effectiveness. Future research should specifically assess which individual components are essential to the success of disease management programs. This information will allow health care organizations and employer groups to make informed decisions regarding program design and structure to achieve the maximum benefit for more individuals with diabetes. In addition to diabetes disease management programs, which can reach a larger segment of the diabetes population, efforts should be made to increase the number of health care professionals with diabetes expertise. Specific focus should involve increasing the number of CDEs because they possess specialized knowledge in providing diabetes care and self-management skills.

Footnotes

  • Gretchen Benson, RD, LD, CDE, is the Heart of New Ulm health care project manager at the Minneapolis Heart Institute Foundation in Minneapolis, Minn.

    • American Diabetes Association(R) Inc., 2010

    References

    1. ↵
      1. National Certification Board of Diabetes Educators
      : Count of CDEs by state and other statistics (1/2010) [article online]. Available from http://www.ncbde.org/news_countCDEs2010.cfm. Accessed 26 February 2010
    2. ↵
      1. Department of Health and Human Services
      : National diabetes fact sheet, 2007 [article online]. Available from http:://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed 27 April 2009
    3. ↵
      1. DCCT Research Group
      : The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986, 1993
      OpenUrlCrossRefPubMedWeb of Science
    4. ↵
      1. U.K. Prospective Diabetes Study 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). Lancet 352:837–853, 1998
      OpenUrlCrossRefPubMedWeb of Science
    5. ↵
      1. Cheung BM,
      2. Ong KL,
      3. Cherny SS,
      4. Sham PC,
      5. Tso AW,
      6. Lam KS
      : Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med 122:443–453, 2009
      OpenUrlCrossRefPubMedWeb of Science
    6. ↵
      1. Zgibor JC,
      2. Songer TJ
      : External barriers to diabetes care: addressing personal and health systems issues. Diabetes Spectrum 14:23–28, 2001
      OpenUrlAbstract/FREE Full Text
    7. ↵
      1. Fitzner K,
      2. Fox K,
      3. Schmidt J,
      4. Roberts M,
      5. Rindress D,
      6. Hay J
      : Implementation and outcomes of commercial disease management programs in the United States: the Disease Management Outcomes Consolidation Survey. Dis Manag 8:253–264, 2005
      OpenUrlPubMed
    8. ↵
      1. Krumholz HM,
      2. Currie PM,
      3. Riegel B,
      4. Phillips CO,
      5. Peterson ED,
      6. Smith R,
      7. Yancy CW,
      8. Faxon DP
      : A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group. Circulation 114:1432–1445, 2006
      OpenUrlAbstract/FREE Full Text
    9. ↵
      1. Disease Management Association of America
      : DMAA definition of disease management [article online]. Available from http://www.dmaa.org/dm_definition.asp. Accessed 1 March 2010
    10. ↵
      1. Kim HS,
      2. Oh JA
      : Adherence to diabetes control recommendations: impact of nurse telephone calls. J Adv Nurs 44:256–261, 2003
      OpenUrlCrossRefPubMedWeb of Science
    11. ↵
      1. Shojania KG,
      2. Ranji SR,
      3. McDonald KM,
      4. Grimshaw JM,
      5. Sundaram V,
      6. Rushakoff RJ,
      7. Owens DK
      : Effects of quality improvement strategies for type 2 diabetes on glycemic control. JAMA 296:427–440, 2006
      OpenUrlCrossRefPubMedWeb of Science
    12. ↵
      1. Knight K,
      2. Badamgarav E,
      3. Henning JM,
      4. Hasselblad V,
      5. Gano AD,
      6. Ofman JJ,
      7. Weingarten SR
      : A systematic review of disease management programs. Am J Manag Care 11:242–250, 2005
      OpenUrlPubMedWeb of Science
    13. ↵
      1. Norris SL,
      2. Nichols PJ,
      3. Caspersen CJ,
      4. Glasgow RE,
      5. Engelgau MM,
      6. Jack L,
      7. Isham G,
      8. Snyder SR,
      9. Carande-Kulis VG,
      10. Garfield S,
      11. Briss P,
      12. McCulloh D,
      13. the Task Force on Community Preventative Services
      : The effectiveness of disease and case management for people with diabetes: a systematic review. Am J Prev Med 22 (Suppl. 4):15–38, 2002
      OpenUrlPubMedWeb of Science
    14. ↵
      1. Maljanian R,
      2. Grey N,
      3. Staff R,
      4. Conroy L
      : Intensive telephone follow-up to a hospital-based disease management model for patients with diabetes. Dis Manag 8:15–25, 2005
      OpenUrlCrossRefPubMed
    15. ↵
      1. Sidorov J,
      2. Shull R,
      3. Torncavage J,
      4. Girolami S,
      5. Lawton N,
      6. Harris R
      : Does diabetes disease management save money and improve outcomes? Diabetes Care 25:684–689, 2002
      OpenUrlAbstract/FREE Full Text
    16. ↵
      1. Piette JD,
      2. Kraemer FB,
      3. Weinberger M,
      4. McPhee SJ
      : Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs health care system. Diabetes Care 24:202–208, 2001
      OpenUrlAbstract/FREE Full Text
    PreviousNext
    Back to top

    In this Issue

    March 2010, 23(2)
    • Table of Contents
    • Index by Author
    Sign up to receive current issue alerts
    View Selected Citations (0)
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word about Diabetes Spectrum.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    The Role of Disease Management in Diabetes Care
    (Your Name) has forwarded a page to you from Diabetes Spectrum
    (Your Name) thought you would like to see this page from the Diabetes Spectrum web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    The Role of Disease Management in Diabetes Care
    Gretchen Benson
    Diabetes Spectrum Mar 2010, 23 (2) 116-118; DOI: 10.2337/diaspect.23.2.116

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Add to Selected Citations
    Share

    The Role of Disease Management in Diabetes Care
    Gretchen Benson
    Diabetes Spectrum Mar 2010, 23 (2) 116-118; DOI: 10.2337/diaspect.23.2.116
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • Footnotes
      • References
    • Info & Metrics
    • PDF

    Related Articles

    Cited By...

    More in this TOC Section

    Departments

    • Smart Connected Insulin Pens, Caps, and Attachments: A Review of the Future of Diabetes Technology
    • Brief Literature Review: The Potential of Diabetes Technology to Improve Sleep in Youth With Type 1 Diabetes and Their Parents: An Unanticipated Benefit of Hybrid Closed-Loop Insulin Delivery Systems
    • Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes
    Show more Departments

    Lifestyle and Behavior

    • Perceptions of Diabetes Self-Efficacy and Glycemic Control in Youth With Type 1 Diabetes
    • Global Well-Being Is Associated With A1C and Frequency of Self-Monitoring of Blood Glucose in Predominately Latinx Youth and Young Adults With Type 1 Diabetes
    • Driving Safety in Adolescents and Young Adults With Type 1 Diabetes
    Show more Lifestyle and Behavior

    Similar Articles

    Navigate

    • Current Issue
    • Papers in Press
    • Archives
    • Submit
    • Subscribe
    • Email Alerts
    • RSS Feeds

    More Information

    • About the Journal
    • Instructions for Authors
    • Journal Policies
    • Reprints and Permissions
    • Advertising
    • Privacy Policy: ADA Journals
    • Copyright Notice/Public Access Policy
    • Contact Us

    Other ADA Resources

    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • Scientific Sessions Abstracts
    • Standards of Medical Care in Diabetes
    • BMJ Open - Diabetes Research & Care
    • Professional Books
    • Diabetes Forecast

     

    • DiabetesJournals.org
    • Diabetes Core Update
    • ADA's DiabetesPro
    • ADA Member Directory
    • Diabetes.org

    © 2021 by the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353.