Diabetes is one of the most common chronic conditions encountered in primary care practice. Diabetes prevalence in adults is approaching 10% (http://www.diabetes.org/diabetes-basics/statistics/ ), and patients with diabetes account for a substantial portion of most internal medicine and family physician practices. Recent estimates suggest that diabetes and its associated complications are responsible for over $100 billion in medical expenditures annually in the United States. Further, the economic costs of diabetes increased by 26% between 2012 and 2017 see reference info ). Over half of those costs are due to potentially preventable diabetes complications, with the vast majority of those due to cardiovascular disease, and a much smaller portion due to advanced microvascular complications such as visual loss, amputation, and end-stage renal disease.

 

Optimizing the care of patients with diabetes is both a challenging and rewarding undertaking.  Statistics on adequate management of diabetes are disappointing, with some studies suggesting that less than 10% of patients are achieving all goals of treatment, even in systems that have engaged in some redesign to optimize chronic disease management. It is notable, however, that these numbers are based on broad definitions of quality that do not take into consideration individual preferences, an essential component of a medical home model and one that will be highlighted in this module.

The Chronic Care Model (CCM) is the most studied and proven approach to practice redesign for chronic disease and is built around developing systems to allow informed, productive interactions between patients and the health care system. It has been studied extensively and gradually revised to form the basis of most conceptions of the Medical Home model of care. The main elements of the CCM include utilization of community resources and support, and health systems changes including clinical information systems, delivery system design, decision support, and self-management support (often integrated with community support). Community support will vary across locales; we will describe a few examples but these should be researched and utilized locally. You can find additional resources and tools to help your practice transform and improve the care of your diabetic patients from the National Institute of Diabetes and Digestive and Kidney Diseases as well as the American Diabetes Association, American Association of Clinical Endocrinologists, and the ACP.