Staged diabetes management: Computerizing a disease state management program

Recently, the Diabetes Control and Complications Trial (DCCT) and other similar studies have demonstrated that near-normalization of blood glucose bz diabetes will reduce complications up to 75% but translation of these results into practice has been difficult. In an attempt to help provide the best possible control of patients with diabetes, we have produced a nat, disease state management system for diabetes, called "Staged Diabetes Management" (SDM) implemented it in over 100 sites worldwide, and developed a computer program to simplify its use. SDM; designed to change the way we deal with patients with diabetes, is based upon five principles: (1) community involvement in setting care guidelines; (2) negotiation of goals with patients; (3) appropriate timelines for therapeutic success; (4) rise of flowcharts for medical decisions; and (5) evaluation of the program. SDM is designed to be altered by a community to meet its needs and resources. It encourages primary care physicians to deliver better diabetes care using a team approach and to refer patients with diabetes to specialists when appropriate. It has a complete set of materials for communities, individual health care providers and patients. SDM has been tested for changes in structure, process and outcomes. A meta-analysis of seven clinical trials with over 500 patients has shown a time-weighted average fall in hemoglobin Ale of 1.7 points (equivalent to a drop in mean blood glucose of about 3.5 mM or 60 mg/dL). Preliminary pharmacoeconomic analysis demonstrates a lifetime cost saving of over $27, 000 per patient. A computer program has been developed for the Microsoft Windows(R) environment that contains a client-server database, based upon DiabCare, for the data file structure.