Key Points
Î Diabetes care is complex and requires that many issues beyond
glycemic control be addressed, among them activity, diet, blood
pressure, lipids and pregnancy.
Î Optimal diabetes management requires an organized, systematic
approach and involvement of a coordinated team of dedicated health
care professionals working in an environment where patient-centered
high-quality care is a priority.
Î The most successful practices have an institutional priority for quality
of care, expanding the role of teams and staff, redesigning their
delivery system, activating and educating their patients, and using
electronic health record tools.
Î Care should be aligned with components of the Chronic Care Model to
ensure productive interactions between a prepared proactive practice
team and an informed activated patient. (A)
Î When feasible, care systems should support team-based care,
community involvement, patient registries, and embedded decision
support tools to meet patient needs. (B)
Î Treatment decisions should be timely and based on evidence-
based guidelines that are tailored to individual patient preferences,
prognoses, and comorbidities. (B)
Î A patient-centered communication style should be employed that
incorporates patient preferences, assesses literacy and numeracy, and
addresses cultural barriers to care. (B)
Î Successful diabetes care requires a systematic approach to
supporting patients' behavior change efforts, including:
• Healthy lifestyle changes (physical activity, healthy eating, nonuse of tobacco,
weight management, effective coping )
• Disease self-management (medication taking and management, self-monitoring of
glucose and blood pressure when clinically appropriate)
• Prevention of diabetes complications (self-monitoring of foot health,
active participation in screening for eye, foot, and renal complications, and
immunizations).
