Disease Management Update
Volume V, No. 18
August 28, 2008

Dear Healthcare Intelligence Network Client,

With the nation's rising obesity rates only getting higher, diabetes is also a growing problem in our population. In this week's Disease Management Update, one study reveals the long-term benefits of weight loss for diabetics, and another proposes a potential link between diabetes and babies delivered by C-section.

Visit HIN's blog to find out what CMS is doing to report on the quality of children's healthcare.

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. Caesarean Babies More Likely to Develop Diabetes
  2. Disease Management Q&A: Tracking DM Program Utilization and Results
  3. HealthSounds Podcast: Building a Diabetes Medical Home
  4. Early Weight Loss Reaps Long-Term Benefits for Type 2 Diabetes
  5. Survey of the Month: Obesity Management and Prevention
  6. Medical Homes: Awareness and Early Successes

1. Caesarean Babies More Likely to Develop Diabetes

Babies delivered by C-section have a 20 percent higher risk than normal deliveries of developing the most common type of diabetes in childhood, according to a study led by a Queen's University research team. The team, led by Dr. Chris Cardwell and Dr. Chris Patterson, examined 20 published studies from 16 countries, including around 10,000 children with Type 1 diabetes and over a million control children.

They found a 20 percent increase in the risk of children born by C-section developing the disease. The increase could not be explained by factors such as birth weight, the age of the mother, order of birth, gestational diabetes and whether the baby was breast-fed or not — all factors associated with childhood diabetes in previous studies.

"This study revealed a consistent 20 percent increase in the risk of Type 1 diabetes. It is important to stress that the reason for this is still not understood. It is possible that children born by Caesarean section differ from other children with respect to some unknown characteristic [that] consequently increases their risk of diabetes, but it is also possible that Caesarean section itself is responsible," said Dr. Cardwell.

To learn more about this research, please visit:

2. Disease Management Q&A: Tracking DM Program Utilization and Results

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Eric Berman, D.O., M.S., medical director for Horizon Blue Cross Blue Shield of New Jersey.

Question: How are you tracking DM program utilization and results?

Answer: (Dr. Eric Berman) We have heavily invested in our information services department. We look at episodic treatment groups, and we now get pharmacy and outpatient laboratory data on each member. We run reports to see what utilization is around different disease entities.

It would be very hard for somebody to cheat the system if they had a BMI of 35 and claimed they had hypertension, but they never received any medication for that. We would see that from our data warehouse. It's not designed to be an oversight, or a "Big Brother" situation. It gives us an idea of the cost of healthcare and utilization and tests effectiveness of these health and education programs. This gives us a handle on the ROI and demonstrates the decreased usage of outpatient labs, surgeries and pharmaceuticals. This hopefully makes our population healthier through complex case management and DM activities.

For more details on obesity in DM, please visit:

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

There are other free email newsletters available from HIN!

Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

To sign up for our free email newsletters, please visit http://www.hin.com/freenews2.html

3. HealthSounds Podcast: Building a Diabetes Medical Home

In another validation of the benefits of the patient-centered medical home model, a unique data exchange between the largest insurer in New Jersey and an 850-physician organization resulted in a member-specific profile for each diabetes patient accessible at the point of care. Partners in Care Medical Director Dr. James Barr describes the fine points of the one-year pilot that joined the DM efforts of Horizon Blue Cross Blue Shield of New Jersey with those of Partners in Care physicians to dramatically improve compliance levels and clinical outcomes for patients with diabetes.

To listen to this complimentary HIN podcast, please visit:

4. Early Weight Loss Reaps Long-Term Benefits for Type 2 Diabetes

Researchers at Kaiser Permanente's Center for Health Research found that losing a moderate amount of weight (a mean of 9.8 percent of body weight) within an average of 18 months of diagnosis helped people with type 2 diabetes to achieve blood pressure and blood glucose levels within the target range. Those improvements remained three years later, even if the weight returned.

"What's critical here is that early weight loss may provide lasting benefits for risk factor control that in turn can reduce diabetes-related complications and mortality," said the Kaiser Center's lead researcher, Dr. Adrianne Feldstein. "We've known for a long time that weight loss is an important component in diabetes treatment and prevention. Now it appears there may be a critical window of opportunity following diagnosis in which some lasting gains can be achieved if people are willing to take immediate steps toward lifestyle changes."

Nearly all adults with type 2 diabetes are overweight and more than half are obese, a condition that is associated with poor blood glucose control and other cardiovascular risk factors. Previous research shows that losing weight and maintaining a healthy weight helps people with diabetes improve glycemic control, reduce blood pressure and improve blood lipids.

"These findings suggest that, even in the face of weight regain, losing weight can have long-lasting benefits in type 2 diabetes," the researchers concluded. "The therapeutic advantage achieved through weight loss is exceedingly important, given the close connection between glycemic and blood pressure control and cardiovascular outcomes."

To learn more about this research, please visit:

5. Survey of the Month: Obesity Management and Prevention

In 2004, HHS reclassified obesity from a lifestyle behavior to a medical condition. And for the last decade, many healthcare organizations have directed initiatives at the estimated 67 million obese Americans, 75 million overweight citizens and 10 million overweight children and adolescents. The obesity epidemic triggers upward of $117 billion in healthcare costs annually and is implicated in a host of related health conditions.

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 its 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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Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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