Staged Diabetes Management

The rising incidence and prevalence of diabetes along with its complications have become a global concern. The necessity for a comprehensive model-targeting primary, secondary and tertiary prevention as well as all levels of care has become apparent. Staged Diabetes Management (SDM) was developed over a decade ago by the International Diabetes Centers, Minneapolis, Minnesota, U.S.A.. SDM was founded on the principle that a detailed understanding of the natural history of diabetes and the underlying defects responsible for the development of hyperglycemia and its associated complications should be the basis of sound clinical decision-making. It relies on clinical pathways to guide the clinicians though the detection, treatment and follow up of each type. Unique to SMD is that each pathway is customized for utilization in collaboration with local physicians and allied heath professionals. Thus far clinicians from 22 countries, using 11 translated versions of SDM, have participated in this process. In Korea, SDM was introduced in 1999 with the foundation of the committee in Korean Diabetes Association (KDA). Taking into account the regional difference in medical practice, resource allocation, availability of pharmacological agents and access to care, this Korean version of SDM was developed to reduce variation in practice, improve screening and detection, tighten glycemic control and to increase surveillance of complications. It has been noted that diabetes contributes to the cost of medical services. One way of reducing the financial burden is to find cost-effective approaches to prevention, detection and treatment of diabetes and its complications. The SDM model directly addresses this issue by seeking ways to optimize the limited resources available for diabetes care, prioritizing treatment, reducing medical error and expanding the role of allied health professionals. As SDM moves into the 21st century, its mission has expanded to encompass the principles of primary and secondary prevention.

Development of standardized therapeutic model in Korean type 2 diabetic patients / 대한내과학회지

BACKGROUND: There are a few limitations in application of staged diabetes management (SDM) program to Korean type 2 diabetic patients because of their unique characteristics, such as non-obese but centrally obese anthropometry and variable relationships between insulin secretion and insulin resistance compared to western diabetic patients. Therefore, we proposed new therapeutic model which considers ethnic characteristics and assesses patient by insulin secretion and insulin resistance. METHODS: We have previously assessed patient's insulin secretion by serum fasting C-peptide level and insulin resistance by insulin tolerance test (ITT) and proposed new therapeutic model: by cut-off value of 2.5%/min in insulin resistance and 1.1 ng/dL, 1.7 ng/dL in insulin secretion. RESULTS: Total 183 patients were enrolled in this program and 59% of total subjects had to change the treatment modality according to this new therapeutic model. Mean fasting glucose level dropped from 177.0+/-38.6 mg/dL (9.83+/-2.14 mmol/L) to 148.2+/-31.2 mg/dL (8.23+/-1.73 mmol/L) (p<0.001), mean postprandial 2 hour glucose level dropped from 255.6+/-60.1 mg/dL (14.19+/-3.34 mmol/L) to 221.1+/-58.4 mg/dL (12.27+/-3.24 mmol/L) (p<0.001), mean HbA1c level dropped from 8.37+/-1.42% to 7.72+/-1.39% (p<0.001) even though baseline group already received conventional treatment. 51.4% of the post-treatment group achieved a HbA1c valued of less than 7.5% compared to 28.4% of the pre-treatment group. CONCLUSION: The new standardized therapeutic model strongly suggests its valuable clinical application in Korean type 2 diabetic patients.