Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies
- American Diabetes Association
Diabetes is a chronic disease that affects >20 million Americans (1) and is characterized by serious, costly, and often fatal complications. The total cost of diagnosed diabetes in the U.S. in 2007 was estimated to be $174 billion (2). To prevent or delay costly diabetes complications and to enable people with diabetes to lead healthy, productive lives, appropriate medical care based on current standards of practice, self-management education, and medication and supplies must be available to everyone with diabetes. This paper is based on technical reviews titled “Diabetes Self-Management Education” (3) and “National Standards for Diabetes Self-Management Education Programs” (4).
The goal of medical care for people with diabetes is to optimize glycemic control and minimize complications. The Diabetes Control and Complications Trial (DCCT) demonstrated that treatment that maintains blood glucose levels near normal in type 1 diabetes delays the onset and reduces the progression of microvascular complications. The U.K. Prospective Diabetes Study (UKPDS) documented that optimal glycemic control can also benefit most individuals with type 2 diabetes. To achieve optimal glucose control, the person with diabetes must be able to access health care providers who have expertise in the field of diabetes. Treatment plans must also include self-management training and tools, regular and timely laboratory evaluations, medical nutrition therapy, appropriately prescribed medication(s), and regular self-monitoring of blood glucose levels. The American Diabetes Association position statement “Standards of Medical Care in Diabetes” outlines appropriate medical care for people with diabetes (5 …