Diabetes Care

Abstract

is epidemic in the United States: in 2005, 20.8 million people had either type 1 or type 2 diabetes,1 and 39 million are projected to have the disease by 2050.2 More therapies than ever are available to treat diabetes, and some outcomes have shown improvements in recent years. But the care of people in the United States with the disease is suboptimal, as Saaddine and colleagues showed.3 Their study found that between 1988 and 2002, one in five people with diabetes had poor glycemie control, with a glycosylated hemoglobin (HbAIc) level at or above 9%. Also, they found that two in five people with diabetes had poor control of low-density lipoprotein cholesterol (a level of 130 mg/dL or higher), and one in three had hypertension (140/90 mmHg or higher). The overall rate of adherence to regimens of all recommended types of care (acute, chronic, or preventive) is only 54.9%. 4 Clinical inertia a failure to treat despite clear indications can explain only part of the lack of improvement.5 The suboptimal state of diabetes care must be addressed, not only to improve the lives of people with diabetes and reduce their risk of comorbidities, but to decrease the financial burden imposed by the illness.6 In a health care system with all its technologically sophisticated and efficient procedures and equipment designed for the treatment of acute illness, what mechanisms and systems are in place for treating chronic illness and support-