Disease Management Update
Volume V, No. 31
December 4, 2008

Dear Healthcare Intelligence Network Client,

Nearly 24 million Americans live with diabetes, and an additional 57 million have pre-diabetes. This week's Disease Management Update looks at the risks faced by elderly diabetes patients as well as the rising medical expenses diabetes patients incur.

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

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Higher Occurrence of Death in Elderly Diabetes Patients
  2. Disease Management Q&A: Identifying Undiagnosed Diseases
  3. HealthSounds Podcast: Improving Outcomes in CHF Patients
  4. Annual Medical Cost Increases for People with Diabetes
  5. Survey of the Month: Tobacco Cessation and Prevention
  6. Better Outcomes Through DM and Case Management Services

1. Higher Occurrence of Death in Elderly Diabetes Patients

For patients with diabetes, thiazolidinediones (TDZs) are an oral treatment option for those who would otherwise have to resort to insulin shots to control their blood sugar levels. Researchers at Brigham and Women’s Hospital (BWH) compared the outcomes of the two TDZs available on the market today and found that in the group of patients using rosiglitazone, there was a higher occurrence of death and a greater risk of CHF in elderly patients, when compared with those using the other TDZ, pioglitazone. The findings appear in the November 24, 2008 issue of Archives of Internal Medicine.

“This could be valuable information for elderly diabetic patients who are considering a TDZ, as well as for physicians prescribing these drugs to patients,” said Dr. Wolfgang Winkelmayer, of the pharmacoepidemiology and renal divisions at BWH and lead author of the study.

After looking at the number of patients who died while on one of the drugs, researchers found that patients taking rosiglitazone were at a higher risk of death, with 15 percent greater mortality among patients using rosiglitazone. In addition, the occurrences of myocardial infarction (MI), stroke and CHF in patients were examined, and the group taking rosiglitazone exhibited a 13 percent greater risk of CHF. However, the study did not establish any differences in the risk of MI or stroke between the groups of patients taking the two drugs.

To learn more about this research, please visit:

2. Disease Management Q&A: Identifying Undiagnosed Diseases

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Philip Bonaparte, M.D., chief medical officer with Horizon NJ Health.

Question: Do programs such as diabetes management do anything to identify undiagnosed diabetes, or are they strictly for those that have already been diagnosed?

Response: (Philip Bonaparte) Our program is for those who have a diagnosis of diabetes. There are those programs that are looking at a prediabetic. Most people with Body Mass Indexes at 40 or above are at high risk of developing Type 2 diabetes. We have a program that looks at obese people, and our focus is on getting them involved and active while trying to prevent them from becoming prediabetics.

For more details on DM programs that connect with hard-to-reach clients, please visit: http://store.hin.com/product.asp?itemid=3755

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!

The HealthCoach Huddle, a monthly e-newsletter, brings you the most up-to-date news on health coaching, from coaching strategies to interviews and quotables from the industry's leading health coaches.

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

3. HealthSounds Podcast: Improving Outcomes in CHF Patients

Collaborative patient care models that empower the primary care nurse to communicate patient needs to physicians have not only improved patient care and outcomes but also fostered a cultural change at Hackensack University Medical Center (HUMC), explains Lenore Blank, a nurse practitioner and administrative manager of HUMC's heart failure and pulmonary hypertension team. Her team is part of Pursuing Perfection, a healthcare quality initiative from the Institute of Healthcare Improvement. As HUMC creates the partnerships mandated by Pursuing Perfection, it is extending the knowledge and benefits they've gained with other organizations — and reducing hospital readmissions in the process.

To listen to this complimentary HIN podcast, please visit:

4. Annual Medical Cost Increases for People with Diabetes

People diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don't have diabetes, a gap that increases substantially each year following the initial diagnosis, according to a study published online in the journal Diabetes Care. In the first study to examine medical cost increases for individuals living with diabetes on a year-by-year basis, researchers at RTI International, an independent, nonprofit research institute based in North Carolina, calculated that a 50-year-old newly diagnosed with diabetes spends $4,174 more on medical care per year than a person the same age who doesn't have diabetes. For the diabetes patient, medical costs go up an additional $158 per year every year thereafter, over the amount they would increase due to aging-related increases in medical expenses.

Most of the increase can be attributed to the cost of diabetes-related complications, such as heart and kidney disease, the researchers found. Once they controlled for complications, the remaining annual increase in medical costs was $75 per year — the bulk of which could be attributed to the increasing need for diabetes medications the longer a person lives with the disease.

"The good news is that many of these costs could be contained through proper diabetes management and lifestyle changes," said lead researcher Justin Trogdon, research economist. "Numerous studies show that losing weight and increasing physical activity, along with maintaining proper blood glucose levels, can substantially delay or reduce the risk for diabetes-related complications. What our study does is to point out that there is also a cumulative, financial impact to the progression of this disease."

To learn more about this research, please visit:

5. Survey of the Month: Tobacco Cessation and Prevention

Groups such as the National Working Group for ACTTION (Access to Cessation Treatment of Tobacco In Our Nation) hope to expand access to comprehensive tobacco cessation treatment to 50 percent of smokers by 2015, and to all smokers by 2020. What is your organization doing in the area of tobacco cessation and prevention? Complete HIN's Survey of the Month on tobacco cessation and prevention by December 31 and you’ll get a free executive summary of the compiled results.

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

6. Better Outcomes Through DM and Case Management Services

McKesson Corporation and CMS Health Integrated are providing CoverColorado with the nation’s first integrated care program for high-risk health plan participants. More than 3,000 people with chronic and high-cost health conditions now have access to an around-the-clock, integrated care program that includes both DM and case management services.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

For more information on the products and services available through the Healthcare Intelligence Network, contact us at (888) 446-3530 / (732) 528-4468, fax (732) 292-3073 or email us at info@hin.com.
All contents of this message Copyright 2008