Endocrine Society calls for integrative approach to improve diabetes care

To provide integrated care for people who have diabetes and may be at risk of developing related medical complications, the U.S. health care system needs to continue building effective multidisciplinary care team models, according to new recommendations issued by the Endocrine Society today.

The Endocrine Society's analysis of the challenges and opportunities created by the Affordable Care Act's (ACA) implementation was published online today in the Journal of Clinical Endocrinology & Metabolism.

The policy recommendations were developed by physician experts in diabetes as a result of the Society's September 2014 policy summit on diabetes and ACA implementation. The endocrinology field includes medical doctors (MDs) who are highly specialized in diabetes management as well as scientists who research diabetes.

An estimated 29 million Americans have diabetes, according to the Society's Endocrine Facts and Figures Report. The condition occurs when the body's ability to process sugar is impaired. In 2012, treating diabetes cost the U.S. health care system $245 billion - a figure that is expected to more than double by 2021.

The number of people diagnosed with diabetes is likely to rise as more people gain health insurance coverage through the ACA. One study found a 23 percent increase in Medicaid patients diagnosed with diabetes in states that adopted the ACA Medicaid expansion, compared to a 0.4 percent increase in states that did not. About one in four Americans with diabetes is undiagnosed, so expanded access to care is likely to lead to earlier diagnosis and treatment.

People who have diabetes face an increased risk of developing other conditions, including eye problems, foot complications than can require amputation, diabetic nerve pain and kidney problems. As a result, they often need see a diverse group of medical specialists such as nephrologists, podiatrists or ophthalmologists who may become part of the patient's "care team."

"A fundamental challenge in diabetes care is how can we transform multidisciplinary care teams to provide optimal care," said the white paper's lead author, endocrinologist Alvin C. Powers, MD, of Vanderbilt University Medical Center in Nashville, TN. "Coordinated care is necessary to ensure the best possible outcomes for people with diabetes. An effective team-based approach must provide comprehensive, continuous and timely care without duplicating any tests or services."

Without enough trained health care providers, it will be challenging to provide this level of care. The Endocrine Society's 2014 workforce analysis found that the supply of endocrinologists who treat adults will outpace the growing demand for their services until at least 2024.

This will mean longer waits for appointments for people with diabetes and other endocrine conditions. The Society recommends training more endocrinologists and primary care providers to adequately treat patients and support integrated care teams for people with diabetes.

The Endocrine Society's recommendations include the following:

• Prevention and management of diabetes and prediabetes should be better integrated into health systems as well as community and employer-based health programs.
• Reimbursement should be reformed to reward health care providers for providing integrated, comprehensive care that complies with industry guidelines for best practices.
• We need an increase in federal funding and other financial support for research to address gaps in knowledge about diabetes care and promote the development of next-generation treatment options.
• The U.S. Food and Drug Administration and Centers for Medicare and Medicaid Services must accelerate the approval process for new treatments that address unmet needs in diabetes care.
• Conduct ongoing research to monitor how ACA implementation affects diabetes outcomes and care models.

"Implementing these policies will improve care for people with diabetes and ensure Americans receive greater value for the hundreds of billions of dollars spent annually to treat and prevent the condition," Powers said.