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The American College of Physicians (ACP) and the ACP Foundation (ACPF) just stocked the diabetes care toolbox with three new tools directed at three levels: the physician office, the health care system, and the patient.
These flagship products of ACP's Diabetes Initiative—the Living With Diabetes guide for patients, the ACP Diabetes Care Guide for team-based practice and assessment, and the Web-based Diabetes Portal—were unveiled at Internal Medicine 2007, ACP's annual meeting, held April 19–21 in San Diego.
"Unfortunately, the gap between what medical science knows how to do and what the U.S. health care system actually delivers for diabetes care is a huge challenge for the nation and for the internists who go on the front line of therapy for this chronic disease," says Alan C. Moses, MD, associate vice president for clinical research and medical affairs in endocrinology at Novo Nordisk. Novo Nordisk funded the 3-year initiative with an unrestricted $9.3 million educational grant announced in 2005 (DOC News, June 2005, page 12).
Collaborating organizations include the American Diabetes Association, the American Association of Clinical Endocrinologists, the American Academy of Physician Assistants, the American Association of Diabetes Educators, and The Endocrine Societty.
"The goals of providing these resources are to increase awareness of the gap between current practice and acceptable standards of diabetes care," says Vincenza Snow, MD, clinical director of the initiative and director of clinical programs for ACP. Additional aims include providing educational interventions to improve diabetes care; increasing physician awareness of what constitutes high quality, evidence-based care; and recognizing medical practices that improve diabetes care, Snow says.
"The purpose is for all the products to work together," she says. "We make sure there is consistency across all the products."
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PATIENT HANDBOOK
Reflecting the philosophy that most diabetes care occurs in the patient's home, not in the physician's office, Living with Diabetes: An Everyday Guide for You and Your Family is designed to look like a magazine, with a relaxed voice and culturally appropriate photos of real diabetes patients and their families in their own homes and workplaces.
Along with health literacy experts and diverse members of the primary health care team, >100 patients with diabetes helped develop the dozens of practical strategies for making small behavioral changes that are included in the guide, according to Hilary Seligman, MD, assistant professor of medicine at University of California, San Francisco.
The booklet offers simple guidance for eating right, being active, checking blood glucose, taking oral medication, and learning about insulin. Available in English and Spanish, it's written at a fifth-grade reading level and offers practical advice for watching portion sizes and successful approaches for overcoming old habits, such as loading up on foods and drinks high in carbohydrates or sugar. The booklet features fitness tips for people who have difficulty walking or experience other obstacles to being active.
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ACP members can order free copies of Living With Diabetes for their patients, and nonmembers can purchase copies at a reasonable cost determined by the quantity ordered. But the idea is not simply to hand over the guide and be done with it, Seligman says. "This requires the backing of the physician's full practice," she explains. "It is a framework around which we can teach people to create action plans with short, concrete goals, which takes between 2 and 4 minutes."
Early qualitative data from a study of 225 diabetes patients who followed the guide for 3 months, with brief counseling from health educators on creating action plans, found that the patients felt more empowered to take care of their diabetes, Seligman says. After 1 month using the guide, three-quarters of the patients reported making behavioral changes, such as walking 45 minutes 6 days a week or limiting chocolate ntake to once a week.
"This is a dramatic improvement over traditional counseling strategies," Seligman says. The data were published in abstract form at the Society of General Internal Medicine meeting in Toronto, held April 25–28.1
The researchers also found that use of the patient-education materials, when combined with focused goal-setting sessions, resulted in improvement in diabetes-related distress, patient activation, self-efficacy, and self-care behaviors.
"Most important, we found that patients really love the warm, conversational tone of the guide," Seligman says. "It is clear that patients participated in every step of the creation of the guide. Patients have told us that use of the guide makes them feel like they can take control of their diabetes."
TEAM-BASED PRACTICE MANUAL
The ACP Diabetes Care Guide encourages collaboration among doctors, nurses, diabetes educators, patients, and other diabetes-care team members. Recognizing that different practice members have different skill sets, the manual can help the team capitalize on each of those sets to implement a quality-improvement program, for example, with small steps being the key, Snow says. The guide includes a print practice manual and a CD-ROM with 81 multiple-choice questions and answers, critiques for assessment, and a tutorial for setting up patient registries.
ACP and ACPF are making 100,000 free copies available at the ACP Diabetes Portal (see "FYI") to internal medicine physicians (generalists and endocrinologists), nurses and nurse practitioners, physician assistants, dietitians, and diabetes educators, who can use the guide to earn continuing-education credit.
"We want the entire practice to use this manual together," Snow
says. "And we want clinical teams to know that the patient is part of
the team." 
Footnotes
More information about all of the ACP Diabetes Initiative products, plus additional resources and research, can be obtained at the Diabetes Portal, http://diabetes.acponline.org.
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