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Staged diabetes management: computerizing a disease state management program

B H Ginsberg1, M H Tan, R Mazze

  • 1Becton Dickinson and Co., Franklin Lakes, New Jersey 07417, USA. barry-ginsberg@BDHQ.BD.COM

Journal of Medical Systems
|May 8, 1998
PubMed
Summary
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Staged Diabetes Management (SDM) improves blood glucose control in patients with diabetes, reducing complications. This system, implemented globally, offers a structured approach to diabetes care and has shown significant clinical and economic benefits.

Area of Science:

  • Endocrinology
  • Public Health
  • Health Services Research

Background:

  • Clinical trials demonstrate that near-normalization of blood glucose in diabetes significantly reduces complications.
  • Translating intensive glucose control strategies into routine clinical practice has proven challenging.

Purpose of the Study:

  • To introduce and evaluate a novel disease management system for diabetes, "Staged Diabetes Management" (SDM).
  • To improve the practical application of evidence-based diabetes care guidelines.

Main Methods:

  • Implementation of SDM across over 100 international sites.
  • SDM is based on five principles: community involvement, patient goal negotiation, defined timelines, flowchart-guided decisions, and program evaluation.
  • Development of a supporting computer program for data management and decision support.

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Main Results:

  • A meta-analysis of seven trials (over 500 patients) showed a mean reduction in hemoglobin A1c of 1.7 points.
  • This HbA1c reduction is equivalent to a decrease in mean blood glucose of approximately 3.5 mM (60 mg/dL).
  • Preliminary analysis indicates lifetime cost savings exceeding $27,000 per patient.

Conclusions:

  • Staged Diabetes Management (SDM) is an effective system for improving diabetes control and reducing complications.
  • The system demonstrates significant clinical benefits and positive pharmacoeconomic outcomes.
  • SDM offers a flexible, community-adaptable framework for enhancing diabetes care delivery.