Managed Care - October 2008 - (Page 46) decreasing macrovascular events and long-term associated costs. 3. CONCLUSIONS The clinical and economic ramifications of the growing diabetes epidemic are staggering. Limitations of current management strategies are evident as only limited numbers of patients achieve glycemic goals, and other manifestations of disease, most notably macrovascular events, exact a huge toll, both financially and on a human level. Recent advances in our understanding of the pathophysiology of diabetes coupled with the introduction of novel therapeutic agents allow us to challenge existing ideas about approaches to treatment. For many patients, dedication to lifestyle changes and aggressive, early combination therapy to address βcell compromise and insulin resistance will ultimately offer a way to improve outcomes. To effect widespread change, however, we expect that managed care organizations will need to modify their vision and policies. Rather than focusing on drug costs per se, an orientation toward wellness, including goals of minimizing complications and maximizing functionality and health, is appropriate. Value-based insurance design looks toward an approach of optimizing disease management through a variety of strategies. Although these ideas need to be evaluated through models and ultimately tested in real-world populations, it appears that good medical practice will result in better outcomes overall, both for individual patients with regard to long-term health consequences and for managed care organizations based on economic impact. REFERENCES 1. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2006;29 (Suppl 1)S4– S42. 2. Bowker SL, Majumdar SR, Veugelers P, et al. Increased cancer-related mortality for patients with type 2 diabetes 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 15. 15. who use sulfonylureas or insulin. Diabetes Care. 2006;29:254–8. Brownlee M. 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