Disease management strategies to optimize cardiovascular risk in type 2 diabetes mellitus

A number of disease management strategies have been developed in the past decade to reduce cardiovascular (CV) risk in adults with type 2 diabetes. On average, such programs improve glycated hemoglobin (A_1c) only 0. 5% and often have little or no effect on blood pressure control or low-density lipoprotein (LDL) control, which are critically important CV risk factors. In a large randomized Medicare demonstration program, diabetes disease management programs were unable to recover fees through cost savings to the Centers for Medicare and Medicaid Services. Available data suggest several strategies to improve the effectiveness and reduce the cost of diabetes disease management: 1) integrate disease management operationally and fiscally with primary care; 2) focus on treatment intensification; 3) focus on blood pressure, LDL, aspirin use, and smoking cessation as well as glucose control; and 4) individualize patient goals based on potential CV risk reduction potential and patient preference to maximize clinical benefit and return on investment for each patient.