Abstract
It has been shown conclusively that control of blood glucose and blood pressure improves outcomes regarding diabetes complications in large trials such as Diabetes Control and Complications Trial (DCCT) and U.K. Prospective Diabetics Study (UKPDS). Yet, these improved outcomes demonstrated in clinical trials are not available to most people with diabetes. In 1994 the authors were able to convince University of New Mexico Hospital administrators that diabetes case management could make a difference in diabetic ketoacidosis (DKA) admissions to ICU, however, the experiment proved to have much broader implications for all patients with diabetes in the institution. The average glycohemoglobin (Abbott Laboratories, Abbott Park, IL; normal range, 4.4% to 6.8%), went from 5% ± 0.8% above the upper limit of lab normal to 1.4 ± 0.4% above the upper limit of laboratory normal, and the trend has continued to the current status with over 60% of patients tested having a glycohemoglobin less than 1% above the upper limit of normal. We will relate the evolution of a program using certified diabetes educators (CDE) as diabetes case managers for patients with diabetes and the impact of the program on diabetes outcomes.
Get full access to this article
View all access options for this article.