dMeetings online diabetes self-management education curriculum offers a new way to educate  patients: five hours of DSME  content developed and delivered by Certified Diabetes Educators (CDEs) and focused on positive patient outcomes reduces health care costs and increases patient and employee productivity. The curriculum, approved for use in both accredited and non-accredited diabetes education programs, is delivered to  patients, anytime, anywhere and on the go. The online DSME/T curriculum has been approved by the AADE  and is delivered across 10 sessions, with each session being about 1/2 hour in length.  The curriculum is based and delivered according to the AADE 7 Self Care Behaviors.

The dMeetings web series can assist a full range of health care professionals in educational efforts: practitioners; family, and primary care practices; endocrinologists; health systems; pharmaceutical concerns; health plans; and corporate wellness programs. HCPs and organizations can administer diabetes education and easily track patient learning progress by knowing exactly what, when and how much they have learned and retained over time.

The series is designed to be easily provisioned to a practice or organization: it accommodates the branding of the organization, and is customizable to the unique approaches of each of their clients. A Learning Management System (LMS) is provisioned with the content allowing educators to track patient activities including progress and usage, quizzes and the ability to chat Q and A. One great feature that educators agree on is that it reduces the repetitive nature of delivering DSME education, allowing more time for personalized coaching and patient attention resulting in the ability to accommodate more patients.

To learn more about the dMeetings program, curriculum, and pricing options, or to schedule a demo, click here.

Survey estimates that diabetes accounts for many more deaths in the United States than are being reported on death certificates — and that diabetes is actually the third leading cause of death.

So when a patient dies from a heart attack, stroke or heart disease that is caused by diabetes or when a patient dies from kidney failure, or if a patient dies 6 months after an amputation, the death certificate does not say that the death was caused by diabetes.  About 12% of deaths in 30- to 84-year-olds from 1997 to 2011 could be attributed to diabetes, the latest data from the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES) indicate. But during that time, only 3.3% of death certificates listed diabetes as the underlying cause of death.

The prevalence of diabetes has been rising rapidly throughout the world. Global age-standardized diabetes prevalence increased from an estimated 4.3% in 1980 to 9.0% in 2014 in men, and from 5.0% to 7.9% in women. The United States is no exception to this trend. Using combined criteria of self-reported diagnosis, fasting plasma glucose and hemoglobin A1c, the prevalence of diabetes among adults aged 20+ rose from 8.4% in 1988–94 to 12.1% in 2005–10. Trends are similar when HbA1c is the sole criterion.

Diabetes is associated with many diseases and disabilities, including ischemic heart disease, renal disease, visual impairment, peripheral arterial disease, peripheral neuropathy, and cognitive impairment. And it can increase the risk for many other diseases, even cancer. It is also associated with mortality. In 2010, diabetes was the seventh leading cause of death in the United States. It was listed as the underlying cause of death on 69,091 death certificates (2.8% of total deaths) and appeared in some location on a total of 234,051 death certificates.

The frequency with which diabetes is listed as the underlying cause of death is not a reliable indicator of its actual contribution to the national mortality profile. The sensitivity and specificity of death certificate assignments of diabetes as an underlying cause of death are low, far below those of administrative records or surveys. People who die with diabetes typically have other conditions that may contribute to death. When both diabetes and cardiovascular disease are mentioned on a death certificate, whether or not diabetes is listed as the underlying cause is highly variable and to some extent arbitrary. For example, it is affected by the decedent’s race and sex, whether the death occurs in a hospital, and the number of cardiologists per capita in the area.

An alternative means of estimating the contribution of diabetes to the national mortality profile is to use nationally representative cohorts to identify the excess mortality risk among people with diabetes. That excess risk can be used in combination with the prevalence of diabetes among deaths to estimate the fraction of deaths that would not have occurred in the absence of diabetes.

Responsibility for approximately 12% of deaths would make diabetes the third leading cause of death in the United States in 2010, after diseases of the heart and malignant neoplasms and ahead of chronic lower respiratory diseases and cerebrovascular diseases.

“When we monitor trends in the health of populations and we look at the mortality statistics,” Dr. Stokes, lead author, noted in a statement, “some major threats to U.S. mortality and life expectancy stand out, like drug and alcohol poisonings and suicide. Diabetes didn’t.”  However, these findings show that diabetes is a major contributor to a shorter lifespan and “reinforce the need for robust population-level interventions aimed at diabetes prevention and care,” the researchers concluded.

According to previous reports, in 2010, diabetes was the seventh leading cause of death in the United States, and it was listed as the cause of death on 69,000 death certificates (2.8% of total deaths). However, death certificates list only one underlying cause of death and tend to underestimate diabetes as the cause, especially if the deceased person had both diabetes and cardiovascular disease, they say.

Instead of looking at death certificates, nationally representative surveys may provide a better estimate of the fraction of deaths attributable to diabetes.

Using this approach, other researchers have reported that, based on NHANES data from 1976 to 1980, diabetes was responsible for 3.6% of deaths in the United States, or 5.1% of deaths if undiagnosed diabetes was included (Am J Epidemiol. 2002;156:714-719).

Diabetes may represent a more prominent factor in American mortality than is commonly appreciated, reinforcing the need for robust population-level interventions aimed at diabetes prevention and care.

Practice Pearls:

• The proportion of deaths attributable to diabetes is much greater than the 3.3–3.7% of deaths in which diabetes is assigned as the underlying cause of death.
• Responsibility for approximately 12% of deaths would make diabetes the third leading cause of death in the United States in 2010. Today it would be much higher if we looked at the actual cause of death and not just the end result.
• The prevalence of diabetes has been rising rapidly throughout the world. Global age-standardized diabetes prevalence increased from an estimated 4.3% in 1980 to 9.0% in 2014 in men, and from 5.0% to 7.9% in women.

PLoS ONE. Published online January 25, 2017. Article

I am a primary care provider in a small private office. A long-term patient of mine, 32 years of age, was recently diagnosed with type 1 diabetes. His insurance is now one I do not participate in. Until his recent diagnosis, he visited annually and paid out of pocket.  He wanted to stay with me for his care. I realized his needs were most likely more than he could afford. He would need to privately pay for my services, which would now be more frequent, his medications would be expensive, and he would need more of a multidisciplinary team to meet his needs.

If you have a “Diabetes Disaster Averted” story, please let us know! If we feature your Disaster Averted in our Diabetes Clinical Mastery Series e-newsletter, you will receive a $25 gift card. Please click here to submit a short summary of the incident, what you feel you learned from handling the incident, and your name and title. If you prefer to remain anonymous, please let us know, but still give us your name and address (so we can send you the gift card).

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Study finds NPs provide comparable quality of clinical care as physicians.

Patients receiving clinical care from nurse practitioners (NPs) have risen over the years. There are several states that allow NPs to practice without physician supervision. This raises a concern as to whether receiving care solely from NPs would be more beneficial than from physicians alone.

Young-Fang Kuo, PhD, and colleagues examined and compared the clinical care that diabetic patients receive solely from either NPs or physicians. The researchers chose to examine diabetes because it is an ambulatory sensitive condition that can lead to hospitalizations, which can be reduced with proper management of the disease state. They hypothesized that “rates of potentially preventable hospitalization would be comparable for patients who received primary care from NPs versus physicians.”

The study included diabetic patients from the national Medicare data who were divided into cohorts that only received care from NPs (93,443 patients) and cohorts that only received care from physicians (252,376 patients). Their primary outcome was the number of hospitalizations for a potentially preventable condition in a given year. They also examined hospitalizations for uncontrolled diabetes.

Results through their multivariable analysis showed that “patients who received care from NPs were less likely to be hospitalized for a potentially preventable condition (OR: 0.90; 95% CI, 0.87-0.93).” In addition, “the association between NP care and hospitalizations for poor diabetes control (eg, hypoglycemia, hyperglycemia, etc.) in the multivariable analysis also showed similar results (OR: 0.94; 95% CI, 0.90-0.98).”

Their findings also showed that “the 4-year mortality rate was 17.15% for patients cared for by NPs and 16.9% for those cared for by physicians (hazard ratio: 1.00 (95% CI, 0.97-1.03).”

Kuo and colleagues proposed that these findings were due to factors that were not able to be controlled in their study. Studies have found that NPs spend more time with their patients, provide them with more information, and have more frequent follow-ups than physicians. In addition to this factor, patients who usually seek care from physicians may have more complex or serious health problems than those who seek care from NPs.

The researchers also found that in nonmetropolitan urban areas and rural areas, there were lower rates of potentially preventable hospitalizations for patients cared for by NPs. However, there was no significant difference between patients cared for by NPs versus physicians in urban areas. This might be due to the shortage of physicians in rural areas and also that physicians who are actually in the rural areas have a larger patient burden, which decreases their ability to spend sufficient time with their patients to properly manage their conditions.

Although Kuo and colleagues hypothesized that care from NPs is comparable with care from physicians, their study showed that clinical care from NPs actually results in less hospitalizations when compared to those receiving care only from physicians. However, due to some of the confounding factors involved, the researchers concluded that their findings support previous research, suggesting that NPs provide comparable quality of clinical care for diabetic patients as physicians.

Practice Pearls:

• Patients receiving care from NPs has less hospitalizations.
• NPs spend more time with patients, provide them with more information, and allows for more frequent follow-ups.
• NPs provide comparable quality of clinical care for diabetic patients as physicians.

Kuo YF, Chen NW, Baillargeon J, Mukaila AR, and Goodwin JS. “Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians.” Medical Care. 2015 Sep;53(9):776-83. Web. 20 Oct 2015.

Registry improvements better track progresses meeting performance indicators.

Chronic Disease registries are now more widely used for government and insurance plans to allocate resources and reward or penalize hospitals and providers based on outcomes. These registries can also influence patients’ choices when it comes to where they want to get their care.

Alan Sacerdote and colleagues examined the validity of the registries by looking into the New York City Health and Hospitals Corporation Diabetes Registry (NYCHHCDR), which included more than 63,000 patients. The registry should have data tracking progress to meet “performance indicators” (PI’s) for improvements over time; however, it only provides a “snapshot” of all registry patients in an institution at a given time.

Targets for different chronic diseases are tracked at PI’s and are being documented 2 to 4 times per year. Providers can document recommendations to help patients meet targets, but patients sometimes follow these recommendations inconsistently. Some of the reasons can be:

•       nonadherence
•       they cannot read or comprehend the labels on their pill bottles
•       they put all their medications in one bottle
•       their prescriptions remain unfilled.

There are several factors that can also influence the registry’ scores, whether it is due to lack of consistency in how to use or input information in the registry, auditors not being adequately trained, or whether the patients never return during the reviewed quarter. There can also be inappropriate PI’s for many patients because there is no one-size-fits-all when it comes to developing and monitoring desired targets for different individuals.

Recently, the registry has acknowledged its shortcomings and developed ways to improve by building an ancillary website. These new changes involved:

• having a stable cohort of patients within each provider’s/facility’s panel so that the interventions can be evaluated for efficacy
• provider PI’s must only indicate provider performance
• PI’s that are evidence-based and is appropriate for the patient’s demographic
• having adequately trained auditors.

Practice Pearls:

• Institution’s registries can influence the resources that it might receive from the government or insurance company and also on patients’ preferences.
• Performance indicators are tracked as meeting certain targets for the different chronic diseases and are being documented 2 to 4 times per year.
• Chronic Disease Registries are being improved upon to better track progresses meeting performance indicators.

Sacerdote A, Inoue T, Liaqat S, and Flores J. Improving the Usefulness of Chronic Disease Registries as a Tool to Improve Patient Outcomes; Observations on Several Years’ Experience with the New York City Health & Hospital Corporation’s Diabetes Registry. Web. 07 Oct 2015.