The Florida Diabetes Master Clinician Program: Facilitating Increased Quality and Significant Cost Savings for Diabetic Patients

  1. Edward Shahady, MD, ABCL, ABFM, FAAFP

    Up to 10% of Americans > 20 years of age have type 2 diabetes, and > 20% have the metabolic syndrome.1,2 The prevalence of both has increased by 33% during the past decade as a result of an increasingly sedentary lifestyle, the epidemic of obesity, the growth of ethnic groups at risk for the disease, and the aging of the population. The prevalence of the metabolic syndrome increases dramatically with age, and 45% of people > 60 years of age have the syndrome. Type 2 diabetes will develop in many of these individuals.1,2

    In the United States, diabetes is the sixth leading cause of death; the leading cause of renal failure (end-stage renal disease), nontraumatic limb amputations, and blindness; and the leading contributor to cardiovascular disease (CVD). CVD accounts for ∼ 70% of deaths in adults with diabetes. The complications associated with diabetes lead to excessive suffering, increased use of health care resources, and excessive costs.3-6

    Despite our increased knowledge and understanding of the pathophysiology and management of diabetes, patient outcomes have not shown a parallel improvement. A large gap exists between our knowledge and our performance.7,8 Based on excellent evidence, the American Diabetes Association (ADA) has set the following goals: hemoglobin A1c (A1C) ≤ 7%, LDL cholesterol ≤ 100 mg/dl, and blood pressure ≤ 130/80 mmHg. Nationally, only 48% of patients are able to reach the A1C goal, and only 33% are at the LDL and blood pressure goals. Only 7% are able to reach the goal for all three at the same time.9 The 58 Florida practices that participate in the Diabetes Master Clinician Program (DMCP) of the Florida Academy of Family Physicians Foundation (FAFPF) have been able to help patients attain better control …

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