The Role of Disease Management in Diabetes Care

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 …