Managed Care - January 2009 - (Page 39)

Clinicians’ view iabetes is already one of the most expensive medical conditions, and the future looks even worse. Between 20 percent and 30 percent of U.S. adults are believed to be at metabolic risk for developing type 2 diabetes or its associate, cardiovascular disease. That is why the diabetes specialist James Rosenzweig, MD, and other members of the Endocrine Society developed a clinical practice guideline aimed at preventing the two deadly diseases in people who are likely to develop them. The guideline was published in the Journal of Clinical Endocrinology & Metabolism in October. Separately, the American College of Endocrinology and the American Association of Clinical Endocrinologists issued a consensus statement in July 2008 recommending a comprehensive treatment regimen for patients with prediabetes. The comprehensive treatment regimen was addressed in a recent issue of MANAGED CARE (See “Prediabetes: Prevalent and Preventable” in the December 2008 issue, available online at http://tinyurl.com/7yvn6c). Rosenzweig, director of diabetes services at Boston Medical Center, chaired an international task force that set out to develop guidelines to address the controversial “metabolic syndrome.” “The metabolic syndrome has been very hotly debated in the literature among endocrinologists and other physicians,” Rosenzweig says. “There are different definitions of what the metabolic syndrome is and different interpretations of how it should be treated.” He assembled a group that included researchers who dispute the validity of metabolic syndrome as well as those who have recommended treatment protocols for the condition. The group ultimately decided to sidestep the concept of metabolic syndrome in favor of a term they could all agree on: metabolic risk. (See “Factors associated with high metabolic risk” on this page.) D Factors associated with high metabolic risk • • • • • • Elevated lipids Reduced levels of high-density lipoprotein cholesterol (HDL-C) Increased plasma glucose levels Hypertension Enlarged waist circumference Prothrombotic state, characterized by increased plasma plasminogen activator inhibitor-1 and fibrinogen Proinflammatory state, recognized by elevations of C-reactive protein • People with at least three of these factors should be considered at metabolic risk, according to the Endocrine Society’s new guideline. People who exhibit any of these seven risk factors should receive special attention from their physicians. “Those are the people that primary care physicians should focus on for more frequent screenings and behavioral interventions and more aggressive treatment to prevent those two conditions from developing,” he says. Among other things, the guideline recommends: • Regular screening for risk by measurement of blood pressure, waist circumference, fasting lipid profile, and fasting glucose. Screening prediabetic patients for diabetes at one- to two-year intervals , using a fasting plasma glucose test or a two-hour oral glucose tolerance test. Emphasis on lifestyle management, including losing weight, improving diet, and increasing physical activity, instead of medication therapy for patients with metabolic risk. A 10-year global risk assessment for cardiovascular disease for all patients having metabolic risk. • • • patient care and patient satisfaction benchmarks. “The amounts available are significant, but just as powerful and just as important is that we make a big deal about the awards,” he says. In 2007, the top medical practice provided perfect diabetes care to more than 30 percent of its patients, while another group cracked the 25 percent mark. Medication therapy management HealthPartners is now evaluating changes to its diabetes care based on findings of a pilot program that showed how outcomes can be improved dramatically. In conjunction with the state of Minnesota, 12 HealthPartners Medical Group clinics — and 700 patients with diabetes — participated in a study to JANUARY 2009 / MANAGED CARE 39 http://tinyurl.com/7yvn6c

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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