Quality Insights: Clinical Quality in Primary Care

Diabetes Care for Adults:
Cholesterol (LDL-C) Good Control

Healthcare quality measure: This measure looks at the adult members (18-75 years old) of the state’s five largest managed care health plans, who have Type 1 or Type 2 diabetes and have good cholesterol levels (LDL-C below 100 mg/dl).

Reasons for this measure: Diabetes is a serious disease. If it is not well controlled, it can lead to death or disabilities such as vision problems, kidney failure, or amputations of the foot or leg. Diabetes can also cause problems in a woman’s pregnancy.

Almost 26 million adults in the United States have diabetes; an estimated three million Americans have diabetes that has not yet been diagnosed. In 2008, over 7% of adults in Massachusetts reported having been told by their doctor that they had diabetes. This was almost double the number of people in Massachusetts reported with diabetes in 1990.

Most adults with diabetes have high cholesterol. Doctors need to screen (test) for high cholesterol in order to prevent other diseases, reduce disabilities, and provide quality care. Adults with diabetes should try to keep their LDL cholesterol levels below 100, which is an acceptable cholestrol level. Good cholesterol control can reduce heart-related complications by 20 to 50 percent.

Costs are high to treat diabetes and its problems. The total cost for diabetes in the United States is about $174 billion each year. These include indirect costs of about $58 billion, such as when employees miss work because of health problems. Direct costs of diabetes are about $116 billion, and include doctor’s visits, screening tests, and medications.

Ways your doctor can help...

  • Teach you about diabetes. This includes ways you can control diabetes with food and exercise. It also includes how to watch for early signs of diabetes complications (problems).
  • Ask you to have a serum cholesterol screening (LDL-C) test each year. Your doctor might also want you to have a complete cholesterol profile which measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
  • Discuss foods to help lower LDL cholesterol. Your doctor may suggest that you eat less saturated fat and cholesterol.
  • Ask you to have eye exams and other tests that measure if your diabetes is under control.
  • May prescribe medications if needed, explain how they work, and teach you how to take them.
  • As needed, refer you to a dietician, diabetes educator, or specialist who can help in your diabetes care.

Ways you can help...

  • Make a diabetes plan with your doctor. This plan should include what foods to eat, how often to exercise, and when to have appointments.
  • Eat the foods you are supposed to eat. This is one of the best ways for you to control your diabetes.
  • Be active each day. This might include taking walks, going to a gym, or doing other types of exercise.
  • Get all the tests your doctor wants you to have. This includes a LDL-C and other tests that measure how well your diabetes is under control.
  • Know that other diseases (such as high blood pressure) can make diabetes problems worse.
  • Go to the doctor at least once a year. Some people with diabetes see their doctors even more often, maybe once every 3 to 4 months. Make sure to keep all appointments, even when you are feeling well.

Ways to learn more...


 

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