A decentralized, patient-centered approach to diabetes disease management in the primary care setting

Although many disease management programs have been developed for diabetes, no single design has proved best for all providers and patient populations. Cost effectiveness is especially relevant to diabetes programs because significant costs of the disease may come from complications that occur later in life, while the costs of the program are incurred immediately. For this reason, diabetes disease management programs with positive outcomes and low implementation costs are of particular importance. We report here on the outcomes of a pilot test of the Steps to Health™ program developed by Abbott Laboratories. The Steps to Health™ program was designed to improve patients' compliance for their diabetes care by increasing their knowledge and understanding of diabetes. The pilot test format utilized a decentralized approach to implement the Steps to Health™ program and included assessments of clinical, process, and quality-of-life outcomes. The study used a prospective, observational, pre-post design. Patients were assessed at enrollment and at 6 months. The primary clinical outcome was glycemic control, as measured by HbA1c. For the 70 patients (18% of enrollment) with complete baseline and endpoint data, mean decrease in HbA1c was 1.7% (p < 0.0001). Clinical process measures of preventive diabetes care showed minor changes in rates between the pre- and postenrollment periods. There was also significant improvement in patient satisfaction regarding their knowledge of diabetes, overall ability to take care of diabetes, and helpfulness of the information received. These results suggest that a diabetes disease management program that is relatively inexpensive and easy to implement, centered on patient education in self-management, can achieve clinically significant improvements in glycemic control for a specific period of time (6 months) and result in a high level of patient satisfaction.