Disease Management Update
Volume V, No. 8
June 19, 2008

Dear Healthcare Intelligence Network Client,

Weight and diabetes often go hand-in-hand. While it's true that patients with diabetes are more likely to be overweight, and being overweight or obese is a leading risk factor for type 2 diabetes, a study in this week's Disease Management Update suggests that weight gain might be healthy for type 1 diabetics. Also in this week's issue, another study weighs in on the results and progress of a 12-week weight-loss program for type 2 diabetes from the Joslin Diabetes Center.

Check out HIN's blog to watch a video explaining how two pilots in the patient-centered medical home for patients with diabetes resulted in improved clinical outcomes and compliance in the two populations and saved millions of dollars in health costs.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Weight Gain Healthy for Type 1 Diabetes
  2. Disease Management Q&A: Marketing the Medical Home
  3. HealthSounds Podcast: Identifying At-Risk Populations
  4. Type 2 Diabetes Weight-loss Plan Yields Long-term Success
  5. Survey of the Month: Primary Care in 2008
  6. Medical Homes: Awareness and Early Successes

1. Weight Gain Healthy for Type 1 Diabetes

Research from the University of Pittsburgh Graduate School of Public Health suggests that gaining body fat may be a good thing for people with type 1 diabetes. The study, which followed 655 patients with type 1 diabetes for 20 years, found that patients who gained weight over time were less likely to die prematurely. Participants in the study, an average age of 28 when entering the study and 44 at its completion, were diagnosed with type 1 diabetes between 1950 and 1980. Researchers measured patients’ BMI and waist circumference and assessed BMI every two years during the study period.

Over the course of the study, 147 deaths occurred. Results showed that patients whose BMI increased the most during the study (two to 11 points or about 10 to 55 pounds) were one-third less likely to die than those who had smaller increases in BMI.

“Gaining a reasonable amount of weight may be a sign patients are getting enough insulin and appropriately controlling their disease, which may partly explain why those who gained weight over time had lower mortality rates,” said Dr. Trevor Orchard, M.D., professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

To learn more about this study, please visit:

2. Disease Management Q&A: Marketing the Medical Home

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Roberta Burgess, a nurse case manager with Community Care Plan of North Carolina with Heritage Hospital in Tarboro, North Carolina.

Question:What type of marketing message entices diabetics to check out the medical home model?

Response: (Roberta Burgess) In our area, health fairs in the community have been effective because we have so many rural communities in North Carolina. Many times, when the hospitals have a health fair and they sponsor it through the church, if it has a diabetic focus and they’re talking about medical homes or conferences, they bring them to their community. That seems to work and gets them more interested. When they focus, when they take the market and bring it to the community through what they’re familiar with, that works best.

Just about every piece of information that we send out, even our printed information that comes from the state, refers to their medical home. Not just for diabetes but for their care. Choose your medical home for this and this. Remember your medical home. You have a medical home. So they’re hearing it more and more.

For more details on proactive care management, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Identifying At-Risk Populations

David Larsen, director of quality improvement at SelectHealth, provides a brief overview of technology's big impact on performance improvement and HEDIS results at SelectHealth. Larsen, along with Dr. Jaan Sidorov, medical director with Geisinger Health Plan, describe how their programs identify potential members for diabetes disease management programs, the interventions given and the impact these programs are having on patient outcomes and the bottom line.

To listen to this complimentary HIN podcast, please visit:

4. Type 2 Diabetes Weight-loss Plan Yields Long-term Success

Researchers at the Joslin Diabetes Center report that a 12-week weight-loss program they devised for patients with type 2 diabetes continues to have a positive, long-lasting effect on weight loss one year later, long after patients are off on their own. The study involved 85 patients with type 2 diabetes, average age 54 years and a disease duration of approximately 10 years. The average weight was 235 pounds, average BMI was 38.4, average hemoglobin A1C was 7.5 percent and average waist circumference was 46.7 inches.

Patients completed the 12-week diet and exercise program and were followed for another year without structured intervention. Twelve weeks of the intervention resulted in an average weight loss of 24.6 pounds — more than a 10 percent reduction — a waist circumference reduction of 3.6 inches, and an average drop of 0.9 percent in A1C to 6.6 percent, indicating good control of blood sugar.

After one year of follow-up, weight remained lower than before the patients began the diet by more than 18 pounds — a long-term loss of 7.6 percent. However, A1C levels increased to approximately 7.4 percent. Overall, 55 percent of participants continued to lose weight on their own. The other 45 percent gained back approximately five pounds, but their final weight remained 2.0 percent lower than their pre-diet weight.

To view more of this study's findings, please visit:

5. Survey of the Month: Primary Care in 2008

Many factors are affecting the primary care system in the United States — a predicted shortfall of PCPs, new models of care, unchanged models of reimbursement, a focus on quality initiatives and increased demands for healthcare IT. Complete our survey on primary care by June 30 and receive a free summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Medical Homes: Awareness and Early Successes

Early pilots of the patient-centered medical home model are making good on the promise of improved outcomes, compliance and care. Get an overview of the medical home concept as well as the highlights from 188 healthcare organization responses to HIN's 2008 non-scientific online survey on the medical home at work.

To download this complimentary white paper, please visit:
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