Systematic Implementation of Customized Guidelines: The Staged Diabetes Management Approach

Diabetes mellitus is a significant public health problem whose worldwide prevalence has been increasing in recent years [1]. Approximately 15 million people in the United States have the disease, one third of whom remain undiagnosed [2]. The disease exacts an enormous economic toll: in 1997, direct and indirect costs of diabetes totaled $98 billion [3]. There is a great imperative to improve diabetes management, as numerous studies reveal that many patients with diabetes receive inadequate care [4–7]. Evidence-based practice guidelines for diabetes have been widely disseminated; however, the literature shows that physicians often fail to utilize guidelines [8–11]. In 1988, a system of care was developed by the International Diabetes Center (IDC), a nonprofit diabetes research and education center located in Minneapolis, MN. Called Staged Diabetes ManagementTM (SDM) [12], the program provides an evidence-based and systematic approach to diabetes management for the primary care physician that can be customized to the needs of the local community. This article will describe the SDM program and discuss its role in improving the quality of care of patients with diabetes.