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Where Do We Go from Here?
- From the Regenstrief Health Center, Richard L. Roudebush Veterans Affairs Medical Center, and the Indiana University School of Medicine, Indianapolis, Indiana. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents.
Moving from research findings to clinical practice is a complex process involving the quality of the data; the readiness of the health care system to accept, implement, and pay for the changes recommended by the findings; and the diffusion of the technology and expertise necessary for implementation. Conference participants believe that the data reported here and by others represent an urgent call to recognize that non–insulin-dependent diabetes mellitus (NIDDM) is a serious disease with costly morbidity and mortality, which can be reduced by a comprehensive therapeutic approach. This approach, outlined in Table 3 of this supplement's introduction (see “Introduction: Risks and Benefits of Intensive Management of NIDDM. The Fifth Regenstrief Conference”), should be the goal of all practitioners. In many ways, the approach is similar to those recommended for hypertension and hyperlipidemia, the other chronic conditions underlying the risk for cardiovascular disease, which is disproportionately present in patients with NIDDM. Even in these areas, however, we are moving slowly [1].
Many patients with NIDDM do not realize the profound implications that this metabolic abnormality has on their survival. Our first step then is to ensure that all patients with NIDDM become aware of the risks inherent in that diagnosis and of the measures necessary to reduce those risks through initial and follow-up patient education. The principles of such educational programs have been extensively reviewed [2-6]. However, many patients do not receive such education, primarily because of limitations on reimbursement [7, 8]. In this supplement, Dr. Berger's article (see “Health Care for Persons with NIDDM: The German Experience”) shows how changes in the reimbursement system in Germany improved the implementation of patient education and outcomes.
In addition to comprehensive patient education, a thorough assessment of the patient's current risk status is needed, including assessment of the specific complications …
This 100-word excerpt has been provided in the absence of an abstract.
