Clinical Evidence Review : Best Practices Diabetes Mellitus Update

Introduction Patients with diabetes mellitus comprise over 10% of Kaiser Permanente (KP) nationwide membership. Because complications accompany the disease, patients with diabetes account for a disproportionately increased share of medical expenditures. In the KP Northern California Region, patients with diabetes use 2.4 times more medical resources than patients without diabetes. Cardiovascular complications of diabetes are particularly excessive and devastating. In the KP Northwest Region, macrovascular complications account for 62% to 89% of the cost associated with inpatient treatment of diabetes-related complications. Historically, treatment of diabetes emphasized control of blood glucose level. However, studies have shown that glucose control alone does not have a statistically significant effect on preventing cardiovascular disease (CVD), although the trend for successful prevention of CVD is in a positive direction. In addition, there is strong clinical evidence that the use of a combination of three medications—aspirin, ACE-inhibitors, and statins—can reduce the incidence of cardiovascular disease by 75%. This article, part of a series highlighting key aspects of guidelines and care programs from the KP Care Management Institute (CMI), is an overview of part of the recently completed 2006 KP National Adult Diabetes Guidelines. Members of the committee that assembled these guidelines are listed in Table 1. One section of the guidelines is devoted to CVD prevention and discusses the evidence supporting seven interventions proven to decrease macrovascular complications of diabetes. The clinical practice guidelines are available at http://cl.kp.org/pkc/national/cmi/ programs/diabetes/guideline/ index.html.