Managing Diabetes The Challenge of Multiple Chronic Conditions. James M Schibanoff MD Editor-in-Chief Milliman Care Guidelines. Diabetes Today. Type I accounts for 5-10% of diabetes Type II accounts for 90-95% and increasing Prevalence in adults 9.6% (20.8 million Americans)
James M Schibanoff MD
Milliman Care Guidelines
Type I accounts for 5-10% of diabetes
Type II accounts for 90-95% and increasing
Prevalence in adults 9.6% (20.8 million Americans)
Diabetic adults twice as likely to die as non-diabetics of same age
Leading cause of blindness ages 20-74
Leading cause of end-stage renal disease
In comparison with other chronic diseases, diabetes is relatively well understood and there is broad-based agreement about how to manage it, but….
DISTRIBUTION OF FAMILY INCOME, UNITED STATES, 2002
Average income $66,970 (Median about $50,000)
SOURCE: Bureau of the Census website http://ferret.bls.census.gov/macro/032003/faminc.
SOURCE: Carroll, John. Erosion of Employer-Sponsored Health Care. Managed Care. January 2007, Volume 16, Number 1, 18-29.
Retrieved at www.managedcaremag.com.
SOURCE: Ortne, Nick. Milliman Research Report. Insight into Two Analytical Challenges for Disease Management. April 2004.
Retrieved at www.milliman.com.
Randomized controlled trials (RCTs) are considered the gold standard of evidence but apply only to select populations with a low comorbid disease burden.
For patients with multiple comorbidities, medication intolerances, poor adherence, or limited cognition, the evidence base is largely nonexistent
7 Steps each with a 20% drop off leads to 21% adoption rate
Coordination of care: fragmented care leads to omissions and overlaps
Patient behavior is the most important determinant of outcome
Current best evidence is favorable but is either indirect or preliminary
In comparison with other chronic diseases, diabetes is relatively well understood and there is broad-based agreement about how to manage it, and…
Our healthcare system will deliver superior diabetes care through innovations in care delivery, evidence, technology, and quality improvement