2.0.0.0 Care Delivery Systems
2.1.0.0 Overview
The proportion of patients with diabetes who achieve recommended A1C, blood pressure, and LDL cholesterol levels has increased in recent years (3). The mean A1C nationally among people with diabetes declined from 7.6% (60 mmol/mol) in 1999–2002 to 7.2% (55 mmol/mol) in 2007–2010 based on the National Health and Nutrition Examination Survey (NHANES), with younger adults less likely to meet treatment targets than older adults (3). This has been accompanied by improvements in cardiovascular outcomes and has led to substantial reductions in end-stage microvascular complications.
Nevertheless, 33–49% of patients still did not meet general targets for glycemic, blood pressure, or cholesterol control, and only 14% met targets for all three measures while also avoiding smoking (3). Evidence suggests that progress in cardiovascular risk factor control (particularly tobacco use) may be slowing (3,4). Certain segments of the population, such as young adults and patients with complex comorbidities, financial or other social hardships, and/or limited English proficiency, face particular challenges to goal-based care (5-7). Even after adjusting for these patient factors, the persistent variability in the quality of diabetes care across providers and practice settings indicates that substantial system-level improvements are still needed.
Diabetes poses a significant financial burden to individuals and society. It is estimated that the annual cost of diagnosed diabetes in 2017 was ≥327 billion, including ≥237 billion in direct medical costs and ≥90 billion in reduced productivity. After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 (8). This is attributed to the increased prevalence of diabetes and the increased cost per person with diabetes. Ongoing population health strategies are needed in order to reduce costs and provide optimized care.