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Defeat Diabetes
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Aggressive Diabetes Education Program Makes Positive Impact

Posted: Tuesday, June 28, 2005

The Arkansas Diabetes Disease Management Program demonstrates how healthcare systems around the country can manage the costs associated with diabetes, while, more importantly, improving the health care of Americans, according to Arkansas Governor Mike Huckabee.

The program was developed through a public/private partnership with Eli Lilly and Company, the Arkansas Department of Human Services and the Arkansas Department of Health's Diabetes Prevention and Control Program.

The objective of the study of the program was to evaluate the cost effectiveness of the state's diabetes education program for Medicaid recipients with diabetes. The program, part of the governor's Healthy Arkansas initiative, began with the selection of 212 Arkansas Medicaid recipients with diabetes to undergo one-hour initial assessments of individual training needs followed by a year-long program with 12 hours of group or individual sessions on nutrition and self-management. These individuals were referred to diabetes education centers established by the program all over the state. The ultimate goal was to teach them how to control their diabetes -- instead of being controlled by it.

"This program was an innovative, data-driven approach to looking for solutions for our diabetes epidemic," said Kurt Knickrehm, Arkansas Department of Human Services director. Medicaid insures almost 25 percent of the state's population, and it costs the state over $3 billion a year to cover the health expenses of the program's patients, he said.

"Initiatives like Lilly's disease management program can potentially have an impact on our Medicaid expenditures in the millions of dollars. This project has helped us understand better how to begin to create some long-term solutions for the diabetes problem," he said. Knickrehm pointed to the example of a 55-year-old patient who, after completing the yearlong program, was able to reduce her doctor visits from every other week to every three months.

To get an idea of the severity of the lack of patient education, Knickrehm points to the discovery by program managers that many Medicaid patients with diabetes are not even aware of how to monitor their own blood glucose levels.

In the disease management program, patients were walked step-by-step through the blood glucose monitoring process, taught how to self-examine eyes, feet and skin for diabetes-related circulatory problems, shown the importance of exercise and taught how to make healthy food choices and adopt better cooking habits.

Diabetes educators took patients on a "field trip" to the local grocery store to teach patients the importance of understanding food labeling. Diabetes Control Center directors involved in the program said the one-on-one and group support components of the program were critical to the patients' success.

The 212 Arkansans in the Arkansas Diabetes Disease Management Program were studied along with individuals in a comparison group who met the study's criteria but did not participate in the program. The researchers used changes from baseline clinical values for the 157 patients who completed the yearlong program to project the effect on diabetes costs and clinical events.

A key clinical finding from the study showed over one year, mean HbA1c (a standard clinical criteria for monitoring changes in patients with diabetes) declined by 0.4 among the 157 program participants who completed their final visit.

The researchers reported the estimated savings in diabetes-related costs projected from observed pre/post HbA1c levels are $415 per program completer (n = 157) over three years. This largely offsets program costs of $335 per initial program participant (n = 212), resulting in a net cost per program participant of $28 over three years. If reductions in diabetes-related costs persist beyond three years, the program may be cost saving, according to the researchers. Further, over 10 years, from a clinical perspective the program is projected to reduce diabetes-related mortality by 9 percent and microvascular disease events by 15 percent among those who completed the program.

The researchers concluded that a diabetes self-management and nutrition education program can reduce resource utilization among Medicaid recipients with diabetes within one year, and is likely to improve diabetes outcomes over time at little or no incremental cost.

Source: Diabetes In Control.com

 
 
 
 
 
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