Managed Care - December 2008 - (Page 40)

diabetes. They’re clear. More people need to be screened, and we encourage health plans to encourage physicians to do that.” ADA issues testing criteria Insurers’ help sought Kirkman believes that the CDC report, 1. Testing should be considered in all adults who are overweight as well as ADA, ACE, and AACE initia(body mass index >25 kg/m2) and have any of these additives, are leading health plans to an intional risk factors: creasing awareness of the risks to patients • Physical inactivity inherent in undiagnosed and untreated • First-degree relative with diabetes prediabetes, says Kirkman. “We view the • Members of a high-risk ethnic population (e.g., African plans as an important part of the adAmerican, Latino, Native American, Asian American, and Padressing this problem,” she says. “As they cific Islander) become more involved, patients and • Women who delivered a baby weighing >9 lb or diagnosed physicians will, as well.” with gestational diabetes Kaiser Permanente officials agree with • Hypertension (>140/90 mm Hg or on therapy for hypertenthat assessment. “We believe that screension) ing and treatment for prediabetes could • HDL cholesterol level 250 mg/dL (2.82 mmol/L) prevent as much as 30 percent of pre• Women with polycystic ovarian syndrome diabetes cases from becoming diabetic,” • Impaired glucose tolerance or impaired fasting glucose on says James Dudl, MD, diabetes leader at previous testing Kaiser Permanente’s Care Management • Other clinical conditions associated with insulin resistance Institute. “What we are certain of is that (e.g., severe obesity and acanthosis nigricans) improved glucose tolerance reduces the • History of cardiovascular disease risk of comorbidities and early diagnosis 2. In the absence of these risk factors, testing for prediabetes can lead to improved care through metaand diabetes should begin at age 45 bolic memory.” 3. If results are normal, testing should be repeated at least at Dudl is referring to large scale clinical three-year intervals, with consideration of more frequent testtrials that have demonstrated that metaing depending on initial results and risk status bolic control achieved early in the course Source: American Diabetes Association. Standards of medical care in diabetes — 2008. Diabetes Care 2008;31 (Suppl 1):S12–54. of diabetes treatment substantially reduces development and progression of diabetes and microvascular complications. One study, “Metabolic Memory in Diabetes was diagnosed when vascular disease became evi— Focus on Insulin,” in the December 2004 issue dent. Now we routinely look for biologic markers of Diabetes/Metabolism Research and Reviews, consignifying a problem and we’re aggressive in noticludes that “comprehensive metabolic control, esfying physicians and patients if lab results reveal a pecially when instituted early, may alter the natuproblem. We are committed to early intervention.” ral history of diabetic complications.” Stasiuk says that “over time, individuals with Prediabetes patients are not treated with insulin, prediabetes fall into one of three nearly equal but “studies do show that treatment early with metgroups: They become type 2 diabetics, they stay formin has benefits during treatment and even 10 prediabetic, or their glucose converts to normal. years later, which implies that the earlier treatment “At this time, we do not know who will fall into starts, the longer benefits last,” says Dudl. which group, but know that two thirds of pre“The guidelines for treatment of prediabetes diabetics are in group one and two and need to adhave not been set in stone yet, but with the growdress their health risk with lifestyle management. ing realization that diabetes is epidemic, there is inThe one third that converts to a normal glucose creased recognition that the risk pool is growing,” level, will not need medication. That is why it is critsays Christina Stasiuk, DO, Cigna’s senior medical ical to try lifestyle management changes first and director for health advocacy. “For too long diabetes foremost,” she says. MC T he American Diabetes Association issued new guidelines earlier this year for health plans and doctors to test patients who may be at risk for prediabetes. They are: 40 MANAGED CARE / DECEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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