Diabetes Management Policies Lack Proactive Components for Disease Management


In 2012, 9.3% of the U.S. population had diabetes according the diabetes.org.  Over 27% of this population with diabetes was undiagnosed and not receiving necessary care. 86 Million US citizens over the age of 20 are pre-diabetic. Patients who develop pre-diabetes are extremely likely to develop diabetes. Inevitably even with treatment, diabetics will develop complications. According to Diabetes.org, the annual cost of diabetes in the US in 2012 was $245 Billion and the incidence is increasing.

diabetes graph

Currently, there is a VA-DOD clinical practice guideline identified for treatment of patients diagnosed with diabetes in the military health system (MHS). This policy is very similar to the American Diabetes Association protocol and universally accepted by providers. There aren’t outcome measures identified to determine if the guideline is achieving the expected outcomes for the patients treated. There aren’t process metrics identified to assist in measuring provider and patient compliance with the clinical practice guideline. This policy includes guidelines for treating patients diagnosed with diabetes but provides no treatment guidelines for patients diagnosed with pre-diabetes.

The policy should be augmented to include pre-diabetes treatment guidelines to minimize the progression to diabetes. This policy should also require surveillance standards to reduce the current trends for under-diagnosing of pre-diabetes and diabetes. Diabetes is a behavioral disease so therefore, disease management is dependent on implementation of behavioral interventions (also omitted from the policy). Self efficacy is the most important predictor of a patient’s ability to self-manage their disease.  The following TedTalk highlights the benefits of educating patients to increase self efficacy rather than instill fear.

The MHS needs a policy that incorporates patient engagement/behavioral intervention, mandatory screening and pre-diabetes clinical practice guidelines. The MHS has one of two options, augment the current policy or create supplemental policies addressing the missing components.



7 Responses to “Diabetes Management Policies Lack Proactive Components for Disease Management”

  1. drrohitjain2010 Says:

    Diabetes is a life threatening condition with multiple long term complication.I agree that diabetes should be diagnose at early stage and treatment should be initiative as early as possible.In VA-DOD clinical practice guidelines only establish patient was included ,pre-diabetic patient were not included.Our guidelines should include pre-diabetic patient to prevent long term life threatening complication like diabetic neuropathy,stroke ,myocardial infarction and diabetic ulcer .In addition to the medical management,the patient education regarding diabetes is also very important,it will increase compliance of the management and prevention of late complication.Early diagnoses that is pre-diabetes stage is important for prevention of long term complication.

  2. kaarimsc Says:

    Thank you so much for this thought provoking post. I agree that incorporating behavioral interventions to help combat chronic diseases such as obesity, hypertension and diabetes is critical. I have found working as a healthcare professional that many providers do not discuss issues around behavior changes. Unfortunately, many providers are only allotted 15 minutes to see and patient and do not have enough time to address behavior change issues as they must address for acute issues. By creating policy to help make this a mandatory aspect of care, this could help change the provider patient encounter to help empower the patient to make changes in their lifestyle to prevent or reverse complications. I believe that a policy like this would help create a better environment for both the patient and the practitioner to work to prevent chronic illnesses. This is just once aspect to prevent chronic illnesses within this country, but I believe can have a great impact as patients are ultimately responsible for their health choices.

  3. nolanm2015 Says:

    Thanks for the post… Clearly pre-diabetes should be a focus for health providers, given the likelihood development of diabetes. I work in a private setting, where employer’s who sponsor health plans are just starting to realize this. They are slowly demanding their health plans identify and focus care on pre-diabetics to reduce diabetes development. The challenge I’ve seen lies in improving understanding of what constitutes pre-diabetes and capturing the information needed to identify when it is often spread around the healthcare system. It would be great to see the MHS work with private partners so both could end up with comprehensive pre-diabetes policies to prevent this disease.

  4. LaithS Says:

    I believe pre-diabetes represents one of the top if not the top of public health issues facing the population in our time. Major changes should be implemented to policies with high impact strategies in mind. Special focus should be given for expanding the implementation of the Diabetes Prevention Program (DPP) which demonstrated successful outcome upon its limited usage.

  5. alenaskeels Says:

    Prevention is always more cost effective than treatment so it makes sense to catch clients as soon as possible, preferably before they exhibit symptoms. How do you propose to tretain clients with a chronic disease on a prevention/treatment plan for life? I imagine the loss to follow up would be extremely high.

  6. alicemann1 Says:

    I agree with the above comments that prevention is generally much more cost effective than treatment and that diabetes prevention should be a huge ficus for clinicians and public health officials. However, as a clinician, I find that any disease that requires lifestyle changes, such as DM, are the most difficult to prevent. ASking patients to change their behaviors is so difficult! It seem that the success rate of trying to change behavior is low. More resources should be put into behavioral research as well.

  7. janetilott Says:

    I really like the fact that you discuss the importance of behavior change in diabetes treatment. Behavior change is absolutely essential, particularly given the high cost of treating, and the fact that it’s a lifelong condition. However, what about even dealing with behavior change before people get to the point of being pre-diabetic? i believe a number of studies have shown that a lot of people are simply not even aware of the fact that they’re at risk. There could be mass public sensitization campaigns, for example. A lot of people don’t know the symptoms of diabetes, and may not even be completely aware of the cause (or may not recognize those causes within their own lifestyle)? What a shame that healthcare providers only get 15 minutes per patient.

    You might be aware that diabetes is increasingly a major problem in developing countries, many of which are facing a double-edged sword of childhood malnutrition and contagious diseases alongside chronic disease. The high costs of the disease are projected to be largely beyond the capacity of healthcare systems with very limited resources in the near future.

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