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Curr Diab Rep. 2017 Jul;17(7):51. doi: 10.1007/s11892-017-0875-2.

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes.

Author information

1
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite no. 333, Baltimore, MD, 21287, USA. sahill@jhmi.edu.
2
Departments of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. sahill@jhmi.edu.
3
Departments of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
4
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
5
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite no. 333, Baltimore, MD, 21287, USA.
6
Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland Medical System, Baltimore, MD, USA.
7
Division of Endocrinology and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
8
Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA.
9
Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
10
Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

PURPOSE OF REVIEW:

The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes.

RECENT FINDINGS:

Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.

KEYWORDS:

Cost-effectiveness; Diabetes mellitus; Diabetes prevention; Inpatient diabetes; Multi-level diabetes interventions; Population health

PMID:
28567711
PMCID:
PMC5553206
DOI:
10.1007/s11892-017-0875-2
[Indexed for MEDLINE]
Free PMC Article

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