Staged Diabetes Management, 3rd Edition

281 Pages·6.703 MB·English

by  Dr. Roger S. Mazze, Ellie S. Strock, Dr. Richard M. Bergenstal, Dr. Amy Criego, Dr. Robert Cuddihy, Dr. Oded Langer, Dr. Gregg D. Simonson, Dr. Margaret A. Powers(auth.)

Staged Diabetes
Management
Staged Diabetes
Management
Roger S. Mazze
Ellie S. Strock
Richard M. Bergenstal
Amy Criego
Robert Cuddihy
Oded Langer
Gregg D. Simonson
Margaret A. Powers
3RD EDITION
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Library of Congress Cataloging-in-Publication Data
Staged diabetes management / Roger S. Mazze ... [et al.]. – 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-470-65466-8 (hardcover : alk. paper)
ISBN-10: 0-470-65466-X (hardcover : alk. paper)
1. Diabetes. 2. Medical protocols. 3. Evidence-based medicine. I. Mazze, R. S. II. International
Diabetes Center.
[DNLM: 1. Diabetes Mellitus–therapy–Practice Guideline. 2. Diabetes Mellitus–diagnosis–Practice
Guideline. WK 815]
RC660.S67 2011
616.4'62–dc22
2011011047
A catalogue record for this book is available from the British Library.
This book is published in the following electronic formats: ePDF 9781119950394; Wiley Online Library
9781119950424; ePub 9781119950400; Mobi 9781119950417
Set in 8.75/11.5 pt Sabon by Toppan Best-set Premedia Limited
01 2012
Dedication
In 2004 we dedicated the second edition of S taged Diabetes entists, educators, clinicians, and people with diabetes. He taught
Management to the memory of Donnell D. Etzwiler, founder and us that it would be selfi sh to accumulate but not share knowledge;
fi rst president of the International Diabetes Center. A person of that successful treatment and education strategies should be dis-
ideas and vision, he was steadfast in his mission to improve the seminated; and that the true importance of scientifi c discoveries
lives of people with diabetes throughout the world. Don wel- was how successfully they were translated into practice. Most
comed the challenges of scientifi c enquiry and the inevitability of important, he taught us that the true hero in this endeavor is the
criticism. He was tireless in his willingness to share his ideas individual with diabetes.
through training programs that reached tens of thousands of We dedicate our third edition to Don’ s fellow travelers, the men
health professionals; yet, he always had time for the child with and women who work to improve the lives of those with diabetes
diabetes. As we enter our 45th year as simply the IDC, his wisdom through research, education and care; and especially to those
seems even more germane to the tasks at hand. His travels rein- individuals with diabetes who as advocates for others emulate
forced a tradition that opened a worldwide dialogue among sci- Don ’ s generosity of spirit.
Contents
About the authors, ix
Acknowledgments, xi
Introduction, 1
Part 1: Diabetes care from the perspective of Staged Diabetes Management
1 Introduction to Staged Diabetes Management, 7
2 Implementation of Staged Diabetes Management, 17
3 Characterization of glucose metabolism, 29
Part 2: The treatment of diabetes
4 Detection and treatment of type 1 diabetes, 43
5 Type 2 diabetes in adults, 77
6 Diabetes in pregnancy, 139
7 Type 2 diabetes and metabolic syndrome in children
and adolescents, 165
Part 3: Diabetes complications and comorbidities and glucose management in the
hospital setting
8 Complications associated with diabetes, 203
9 Diabetes-associated comorbidities, 251
10 Glucose management in the hospital setting, 261
Index, 273
vii
About the a uthors
Roger S. Mazze PhD is the Head of the World Health Organization Bergenstal was named the American Diabetes Association ’ s
Collaborating Center at the International Diabetes Center (IDC) Outstanding Physician Clinician of the Year. His clinical research
and Mayo Clinic and Professor as well as Vice President of the has focused on glucose control and diabetes complications as a
Park Nicollet Institute and Chief Academic Offi cer of the IDC. Principal Investigator of two National Institutes of Health trials:
For the past 24 years he has held the rank of Clinical Professor the Diabetes Control and Complications Trial in type 1 diabetes
of Family Medicine and Community Health at the University of and the Action to Control Cardiovascular Risks in Diabetes study
Minnesota Medical School, and, previously, Professor of in type 2 diabetes. Dr. Bergenstal ’ s clinical efforts have been
Biostatistics, Epidemiology, and Community Health and Executive directed toward improving systems of care for patients with dia-
Director and Coprincipal Investigator of the Diabetes Research betes by translating new research fi ndings into practice. He
and Training Center at Albert Einstein College of Medicine. He teaches nationally and internationally on the importance of
was also Distinguished Visiting Scientist of the United States patient - centered team care, and has been listed in Best Doctors in
Centers for Disease Control. Dr. Mazze is a past Cochairperson America on numerous occasions. Dr. Bergenstal ’ s contributions
for the American Diabetes Association Council on Health Care focused on assuring continuity between sections and a future
Delivery. Author of more than 100 articles, chapters, comments, perspective.
and arguments, he served as visiting professor to medical schools
throughout Europe, Asia, and Latin America. As principal author Amy Criego MD MS attended undergraduate and medical school
of S taged Diabetes Management ’ s three editions, beyond his own at the University of North Dakota. She underwent residency train-
contributions, his responsibility was to provide a single “ voice ” ing in pediatrics at DeVos Children ’ s Hospital in Grand Rapids,
to the text. MI, and completed her fellowship training in pediatric endo-
crinology at the University of Minnesota. She joined the Pediatric
Ellie S. Strock APRN - BC FAANP CDE is Director of Technology Endocrinology group at Park Nicollet Clinic/International
Development and Translational Research at the International Diabetes Center in 2005 and became the Department Chair for
Diabetes Center and Chief Education Director for the World Pediatric Endocrinology in 2009. She continues to care clinically
Health Organization Collaborating Center at the International for children with diabetes and other endocrine disorders while
Diabetes Center and Mayo Clinic. She is a board - certifi ed Adult actively participating in research and medical education. Dr.
Nurse Practitioner for Park Nicollet Health Services. Mrs. Strock Criego has been involved with the collaboration between the
served as co - investigator on numerous clinical trials focusing on diabetes and eating disorder teams at the International Diabetes
advanced technologies and clinical decision - making. She organ- Center and Melrose Institute since joining Park Nicollet in 2005.
ized and directed Staged Diabetes Management (SDM) training Her contributions to the text focused on children with type 1 and
programs throughout the USA, Europe, Asia, and Latin America type 2 diabetes.
and has been recognized as a leader in international patient and
professional education. In 2009, she was inducted as a Fellow of Robert Cuddihy MD is Vice- President— Medical Diabetes Head,
the American Academy of Nurse Practitioners (FAANP) and in US Medical Affairs, Sanofi US. Before joining Sanofi - Aventis, Dr.
2011 was named Visiting Professor at Nanjing Medical University, Cuddihy was Medical Director at the International Diabetes
Nanjing, China. Mrs. Strock has authored more than 40 articles Center and Associate Professor at the Univ ersity of Minnesota
in national and international journals. As coauthor of Staged Medical School. Before joining the Intern ational Diabetes Center,
Diabetes Manage ment , she contributed to the original ideas that Dr. Cuddihy was at the Massachusetts General Hospital Diabetes
led to the development of SDM, served as the major content Center in Boston and served as Chairman of the Division of
organizer and reviewer throughout all chapters, and lent her Endocrinology at Newton- W ellesley Hospital and as Assistant
practical expertise to assuring a focus on patient education and Clinical Professor of Medicine at Harvard Medical School. He
nutrition. taught extensively in diabetes- r elated courses at Harvard Medical
School and in Harvard Medical School/Massachusetts General
Richard M. Bergenstal MD is an endocrinologist and Executive Hospital- s ponsored national/international continuing medical
Director of the International Diabetes Center at Park Nicollet. He education courses. Before practicing in Boston, Dr. Cuddihy was
is Clinical Professor in the Department of Medicine at the a staff physician and Assistant Professor at Mayo Clinic/Mayo
University of Minnesota and served as President, Science & Medical School. He also served as the Associate Program Director
Medicine of the American Diabetes Association. In 2007, Dr. of Mayo’ s Internal Medicine residency program. Dr. Cuddihy
ix
ABOUT THE AUTHORS
reviewed each chapter, adding both common sense and scientifi c academic appointment as Adjunct Assistant Professor in the
rigor. Department of Family Practice and Community Health at the
University of Minnesota Medical School. Dr. Simonson earned
Oded Langer MD is the Babcock Professor and Chairman of the
his doctorate in molecular cell biology and biochemistry at the
Department of Obstetrics and Gynecology at St. Luke ’ s - Roosevelt
University of Minnesota. He held a postdoctoral research position
Hospital Center, a University Hospital of Columbia University.
at the University of Wisconsin Children ’ s Diabetes Center and
He graduated from Sackler Medical School in Israel, and obtained
was awarded a Juvenile Diabetes Foundation Postdoctoral
his PhD from Poznan University of Medical Science. In the course
Fellowship for his research on diabetes gene therapy. Dr. Simonson
of his career and his longtime interest in high - risk pregnancy,
is a member of the American Diabetes Association and Chair
particularly diabetes in pregnancy, Dr. Langer has served as prin-
of the Minnesota Department of Health Diabetes Steering
cipal or coinvestigator on several National Institutes of Health
Committee. His contributions focused on type 2 diabetes and
and pharmaceutical grants. He was principal investigator of the
complications.
Maternal Fetal Medicine Unit Network (NICHD) in San Antonio,
TX. In addition, on multiple occasions his work was recognized
with the Award of Research Excellence from the Society of Margaret A. Powers PhD RD CDE is a registered dietitian and
Maternal – Fetal Medicine. Dr. Langer has over 200 peer- reviewed certifi ed diabetes educator. She is a Research Scientist at the
articles in obstetrics and maternal – fetal medicine; over 49 chap- International Diabetes Center, where her research focuses on
ters and review articles; and more than 310 accepted abstracts performance improvement with organizations and individuals to
presented in both national and international forums. He has improve diabetes outcomes. She recently completed research with
served on a variety of journal editorial boards and has been a 12 health organizations around the county that focused on
guest editor and ad hoc reviewer for many peer- reviewed journals. improving blood pressure measures in people with diabetes.
In addition, he has authored a textbook on diabetes in pregnancy Additionally, she is pioneering work with continuous glucose
and coauthored four additional textbooks on diabetes in preg- monitoring to study the glycemic response to food. Dr. Powers
nancy. Dr. Langer contributed tirelessly to the pregnancy sections has been instrumental in designing programs that help health
of the book, making certain that scientifi c evidence, not opinion, organizations improve diabetes care and education and in devel-
be the basis of treatment of diabetes in pregnancy. oping additional programs and products designed to improve
healthcare outcomes. Throughout the text she assured that nutri-
Gregg D. Simonson PhD is Director, Professional Training and tion was addressed, balancing the scientifi c evidence with a
Consulting at the International Diabetes Center and holds an behavioral approach.
x
Acknowledgments
It is generally a daunting task to identify and thank those indi- have been impossible. Helping Jeanne and me fi nd all of the
viduals whose extraordinary efforts made this work possible. In fi gures, produce new drawings and organize them to fi t the text
this case it is quite simple. Jeanne Mettner worked almost 1 year was Bryan Akkerman. His work was somewhat monumental as
to guide the authors through the creation of this third edition of more than 100 fi gures had to be produced and properly placed
Staged Diabetes Management . She acted as research, content, in the text. We are very grateful that the production stages of
copy, and production editor. Without her, seven authors could this book were so ably undertaken by Lindsey Williams, on
not possibly have completed their work. As principal author I behalf of Wiley - Blackwell. Lindsey ’ s patience and support have
relied on Jeanne to help capture the unique contributions of been integral in making sure this book turned out so well. The
each of the authors and then to organize them into a coherent authors are also grateful to the International Diabetes Center
single work. Each chapter was ultimately my responsibility to staff, most especially my program coordinator, Dina Melnik, and
form into a single voice. Without Jeanne ’ s assistance it would our editors at Wiley - Blackwell for their devotion to this project.
xi
Introduction
Staged Diabetes Management (SDM) is a systematic approach to edly improving diabetes care outcomes. Because of this stagna-
preventing, detecting, and treating diabetes, metabolic syndrome, tion, researchers have initiated studies to determine precisely
and associated disorders. It uses practice guidelines and clinical which factors have stalled the trend towards improved care.
pathways, or algorithms, which refl ect the responsibilities of the
diabetes care clinician, especially the primary care provider and The c ase for an i ntegrated m odel of o rganizational
the primary care team. c hange in h ealthcare d elivery
The purpose of SDM is as follows: The most accepted method of encouraging change continues to
• to provide an organized, evidence- based approach for clinical be a combination of (1) improving the competency of clinicians
decision- making through ongoing professional education and (2) the development
• to provide a consistent set of scientifi cally based practice guide- of mechanisms for rapid translation of research fi ndings and care
lines that can be adapted by a community according to its innovations into practice. In part because of the failure of this
resources approach, there has recently been a reemphasis on government -
• to identify appropriate criteria for initiating and altering thera- issued care guidelines, direct patient involvement in treatment
pies during three treatment phases: start, adjust, and maintain decisions, and public awareness campaigns. 5 The purpose of this
• to provide a common, customized Master DecisionPath for the redirection is to ensure better compliance with treatment recom-
metabolic syndrome and each type of diabetes that both mendations and to enhance the ability for disease self - management.
patients and providers can use to understand treatment options, Such strategies have in common multiple goals: improve care,
to enhance communication, and to optimize therapies lower cost, reduce error, and satisfy both the patient and payer.
• to facilitate the detection and treatment of diabetes, insulin Not surprisingly, single strategies are likely to fail, and successful
resistance, and their complications by primary care providers, strategies are characterized by a multifaceted approach. 6
in consultation with specialists
• to foster a patient- centered team approach to the management Theoretical p rinciples for an i ntegrated a pproach to
of diabetes and associated complications. d iabetes c are
SDM does not occur in a vacuum. It requires careful prepara- Consistent with this new strategic direction in chronic disease man-
tion in order to assure successful implementation. This prepara- agement, the International Diabetes Center’ s approach to innova-
tion requires addressing four key areas that affect change: tions in diabetes care is multifaceted and based on an integrated
organization, innovation, measurement, and incentives. The fol- model (Figure 0 .1 ). Within this model, the initial stimulant of
lowing section explains the theoretical framework at the founda- change can come from any component of the healthcare delivery
tion of SDM as it is translated into practice. system. However, in order for the change to be successful, several
key early ingredients are required, including alignment, specifi city,
application of evidence- based data, and customization.
From t heory to p ractice: an i ntegrated
a pproach to d iabetes c are Alignment of p olicy, v alues, and r esources
Alignment of policy, organizational values, and resource alloca-
Research worldwide has indicated that the quality of diabetes care tion, however, are recognized as early requirements if change is
in both developed and developing countries, whether at major to be successful. For this alignment to occur, the following must
medical centers or in small clinics, is suboptimal. 1 – 4 Despite be in place:
numerous attempts to raise the level of care, studies show that • organizational buy - in to the theoretical principles, which may
the sentinel events that characterize diabetes care — the level of require organizational alignment and/or o rganizational change
hemoglobin A (HbA ), retinal and neurological examinations, • identifi cation/recognition of the change champion— a clinical
1c 1c
screening for renal disease, blood pressure management, smoking or administrative leader who directs all efforts that support the
cessation, and patient education — have had little effect on mark- required changes
Staged Diabetes Management, Third Edition. Roger S. Mazze, Ellie S. Strock, Richard M. Bergenstal, Amy Criego, Robert Cuddihy, Oded Langer, Gregg D. Simonson,
Margaret A. Powers.
© 2011 John Wiley & Sons, Ltd. Published 2011 by John Wiley & Sons, Ltd.
1
INTRODUCTION
Organization Incentives
Policy Reimbursement
(cid:129) Private healthcare
(cid:129) Assure organizational fit
(cid:129) Health insurance
(cid:129) Match organizational climate
(cid:129) Public healthcare
Champion Values
Pay for performance
(cid:129) Clinical leader
(cid:129) Organizational and individual
(cid:129) Administrative leader
payments
(cid:129) Improvement
Resource allocation
(cid:129) Meeting standards
(cid:129) Based on cost/benefit analysis
(cid:129) Requires organizational
commitment to change Quality assurance
(cid:129) Align with legal/contractual and peer review
obligations
(cid:129) Assign authority
Leadership Standards
Information technology
Learning
(cid:129) Evidence-based medicine
Customized
(cid:129) Reflects the current medical Implementation
culture and system Clinical Educational Administrative Patient
(cid:129) Standards (cid:129) Knowledge (cid:129) Financial (cid:129) Clinical
(cid:129) Processes (cid:129) Skills (cid:129) Utilization (cid:129) Educational
Skills development (cid:129) Outcomes development review (cid:129) Scheduling
(cid:129) Adherence (cid:129) Quality (cid:129) Satisfaction
(cid:129) Operationalization of care assurance (cid:129) Patient-
guidelines through (cid:129) Reimbursement centered
care
observation of practice
Implementation planning Measurement
(cid:129) Recognition of obstacles to
implementation
(cid:129) Plan for each obstacle
Innovation
Figure 0.1 Model for organizational change in healthcare.
• identifi cation of the clinical issues that have made change and adjusting each therapeutic intervention. Specifi city also
necessary— recognition of a problem that can be quantifi ed permits the development of an implementation plan. The imple-
establishes the criteria by which the intervention will be mentation plan is based on a healthcare system ’ s unique needs
measured. and will facilitate the effi cient use of the clinical pathways.
(Chronic conditions, such as diabetes, are especially suited to this
Process s pecifi city and c are s pecifi city approach.)
By quantifying the clinical problem, healthcare administrators
and clinicians can specify precisely how the clinical problem will Use of e vidence- b ased d ata
be addressed— t hen use outcomes data to gauge how well these Establishing standards of care in the absence of an evidence-
interventions are working. Specifi city requires suffi cient details, based, targeted approach to changing care has often been cited
such as clinical pathways that provide the criteria for initiating as the key factor explaining poor care practices. Most approaches
2