Diabetes

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Accountable care is forcing providers to develop new capacities and strategies for managing cost and quality trends. Prospectively managing the health of populations requires shifting the focus of care delivery from episodic interventions to continuous population management. As a result, accountable care organizations (ACOs) are dedicating considerable focus to developing the infrastructure and tools needed to help patients manage their chronic conditions. This is a significant departure from traditional care-delivery models and will require provider organizations to develop new partnerships and embrace new methods.

A new Kentucky state law that expands prescribing authority for advanced practice registered nurses took effect Tuesday, the same day that a study was published touting the benefits of having nurses manage care for patients with chronic conditions such as diabetes and high blood pressure.

People with type 1 or 2 diabetes now have a new means of getting their medication, with the U.S. Food and Drug Administration's approval on Friday of the first inhaled medicine for the blood sugar disease.

Geisinger Health System's use of a diabetes care system among high-risk patients produced lower risks of myocardial infarction, stroke and retinopathy over a three-year period, according to a study in The American Journal of Managed Care. Best of all, most of the benefit accrued in the first year of care.

Most illnesses today are measured in terms of their effects on daily activities, but who do not always consider the outcomes based on the patient's perspectives. Many clinical studies instead apply standardized measures that identify quality of life as an important outcome. Advancing research methodologies, including new approaches to clinical research, should inform this discussion by centering medical decision making on the preferences of the most important stakeholder-the patient.

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