Diabetes Care Management Teams Did Not Reduce Utilization When Compared With Traditional Care: A Randomized Cluster Trial

Diabetes Care Management Teams Did Not Reduce Utilization When Compared With Traditional Care: A Randomized Cluster Trial
Professor of Medicine (Adjunct), Stanford School of Medicine, (Retired); Director, Chronic Care Program, Santa Clara Valley Medical Center, (Retired)
Purpose: Health services research evaluates redesign models for primary care. Care management is one alternative. Evaluation includes resource utilization as a criterion. Compare the impact of care-manager teams on resource utilization. The comparison includes entire panels of patients and the subset of patients with diabetes.
Design: Randomized, prospective, cohort study comparing change in utilization rates between groups, pre- and post-intervention.
Methodology: Ten primary care physician panels in a safety-net setting. Ten physicians were randomized to either a care-management approach (Group 1) or a traditional approach (Group 2). Care managers focused on diabetes and the cardiovascular cluster of diseases.
Analysis compared rates of hospitalization, 30-day readmission, emergency room visits, and urgent care visits. Analysis compared baseline rates to annual rates after a yearlong run-in for entire panels and the subset of patients with diabetes.
Results: Resource utilization showed no statistically significant change between baseline and Year 3 (P=.79). Emergency room visits and hospital readmission increased for both groups (P=.90), while hospital admissions and urgent care visits decreased (P=.73). Similarly, utilization was not significantly different for patients with diabetes (P=.69).
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10 Best Foods for Fighting Diabetes

By Gary Greenberg | Sunday, 10 September 2017 11:48 AM
A staggering 30 million Americans have diabetes (9.4 percent of the U.S. population) and another 84 million with prediabetes are on the verge, according to the latest projections by the Centers for Disease Control and Prevention.
Millions take medications to combat the life-threatening metabolic disorder. But the truth is that many foods work as effectively as drugs or more so in controlling blood sugar, experts say.
For the most part, the best foods for fighting diabetes are those that dont pad the waist.
Legumes, greens, whole grainsthese are the types of foods that fill you up before filling you out, says registered dietician Joan Salge Blake. Thats important because 70 percent of American are overweight, and being overweight increases the risk of getting Type 2 diabetes.
The U.S. is in the midst of a type 2 diabetes epidemic, and things are likely to get worse.
About 84 million Americans have prediabetes, which means theyre on deck to get diabetes, says Blake, a clinical associate professor at Boston University's Sargent College of Health and Rehabilitation Sciences. Thats where diet and exercise can really have an impact on diabetes risk.
By now, we should all know what kinds of food increase risk of diabetes. Processed foods loaded with added sugar, simple carbs, and unhealthy fats tops the list. Other popular culprits include sweetened soft drinks, anything deep-fat fried, pizza and exotic coffee concoctions.
But some foods have special powers to help normalize blood sugar due to their high content of Continue reading

Diet Instructions For Patients With Diabetes

Home Living Healthy Diet Instructions For Patients With Diabetes
Diet Instructions For Patients With Diabetes
Even if you're trying to reduce your risk of diabetes or manage a pre-existing problem, you can still enjoy your favorite foods and take pleasure from your meals, suggests Dr Sujeet Jha.
By:Dr Sujeet Jha| Updated: Nov 13, 2017 04:00 IST
It is important for diabetics to keep a check on what they eat and when
Eating right is a key step in preventing and controlling diabetes
Diabetics have to be careful about what they eat when
People with more weight around the tummy are more insulin resistant
There is much controversy regarding what diet to recommend to people suffering from diabetes mellitus. The diet most often recommended is high in dietary fiber, especially soluble fiber, but low in fat (especially saturated fat).
Eating right is a key step in preventing and controlling diabetes. Fortunately, whether you're trying to reduce your risk of diabetes or manage a pre-existing problem, you can still enjoy your favorite foods and take pleasure from your meals.
Also read: These Are By Far The Best Yoga Asanas To Keep Your Diabetes Under Control
There are so many healthy traditional ingredients available in Indian market which increases the chances of eating really healthy, such as an array of spices, ginger, garlic, dal (pulses), chana, rice, wholemeal chana atta(flour), jowar/ millet/ bajra atta(flour); vegetables like bhindi, brinjal; fruits like papaya, mango (it's not an error in printing). The concern is the quantity of the food, quantity of ghee (satur Continue reading

Diabetes Self-Management Education and Support (DSMES)

Home / Resources / Articles / Diabetes Self-Management Education and Support (DSMES)
Diabetes Self-Management Education and Support (DSMES)
Once the patient is educated, they should be allowed to take charge of their care.
DSMES is an important tool that helps in averting diabetes complications. With an excess of 79 million Americans being diagnosed with prediabetes or at an increased risk of developing diabetes, DSMES incorporates lifestyle changes designed for individuals with prediabetes to delay and even prevent progression to diabetes status. Participants are the ones who do the most in the daily management of their condition and the educators primary role should be to make the patients work easier.
DSMES are designed in reference to the National Standards for Diabetes Self-Management Education and support. Diabetes educators apply the DSMES standards as teaching tools for evidence-based education of diabetes patients. No single approach is identified as a solution to all problems as each patient is unique and should be treated according to their specific needs. The 10 DSMES program standards as outlined in the ADA guideline include;
All providers are expected to have an organizational structure with a mission statement and goals. DSME should be used and applied by the organization in providing diabetes care to its patients
The community and other individuals with vested interest in the DSME program such as health care professionals, and people with diabetes should be involved in order to boost its quality. This will make it more effective, useful in different Continue reading

UCSF and Partners in Mexico Study Treatment to Prevent Diabetes

A medication shown to delay the onset of type 2 diabetes in people with prediabetes could make a big difference in Mexico, California, and globally through a partnership involving UCSF Institute for Global Health Sciences (IGHS) and the Center for Vulnerable Populations.
Drs. Jaime Sepulveda, IGHS executive director, and Dean Schillinger, UCSF School of Medicine diabetes expert and primary care physician, are leading the UCSF side of a partnership with Mexican health officials. The team is running a large-scale trial of metformin, a low-cost and safe diabetes medication derived from the French Lilac, in Mexico City’s health system that serves low-income patients.
“This is truly an unprecedented opportunity,” Schillinger said. “To be able to do this kind of practice-based research in the real world is exceedingly rare and will shed light onto a major global health problem.”
The partnership came about through Sepulveda’s work as co-chair of the UC-Mexico Initiative Health Working Group. The initiative was created by UC President Janet Napolitano in 2014 to encourage partnerships between the University of California and Mexico in areas of joint interest and benefit.
Diabetes has taken an increasingly large toll in Mexico in the past few decades, especially among populations of lower socioeconomic status. From 1994 to 2006, the prevalence of diabetes in Mexico doubled, according to a 2013 paper published in Globalization and Health. Diabetes is the leading cause of death and disability combined in Mexico, according to the Institute for Health Metrics and Evaluation. Continue reading