Excellence in diabetes programs   (August 26, 2007)

A while back I was asked to identify the top five facilities in the U.S. which specialize in treating diabetes. I'm not in a position to list "the top five" programs. But I'll list several criteria that could help you to identify excellence:

• Is the educational program Recognized by the American Diabetes Association? ("Recognition" is a voluntary process that formally identifies diabetes patient education programs that meet the National Standards for Diabetes Self-Management Education Programs. A list of Recognized Patient Education Programs is available at the ADA's website.
• Are the providers Recognized by the National Committee for Quality Assurance and American Diabetes Association? The NCQA and ADA cosponsor a program called the Diabetes Physician Recognition Program to rate the medical care given to people with diabetes (how many of their patients get A1Cs regularly, and eye exams, and foot exams, and other items that are standard in diabetes care). For more informaiton, see Diabetes Physican Recognition Program.
• Do the members of the diabetes team have Certification as diabetes educators? The CDE initials indicate that the health care professional has met the standards of the National Certification Board for Diabetes Education as having the credentials to teach diabetes care.
• Is the program convenient (in terms of distance)? The best program in the world is no good if you can't get there and back regularly: followup is critical in the care of people with chronic medical disorders such as diabetes.
• Do the members of the diabetes team interact well with each other, and with the patients? Does the patient see the same team members on successive visits, or is the patient bounced around from one person to another? Do the health professionals seem to have time, or act "too busy"? These issues of "bedside manner" are very difficult to rate, and every person has the right to develop their own opinion after being in the program for a while. Sometimes the opinions of other physicians or other patients might offer some clues on what to expect, but I've learned that such opinions vary - widely!
• Are the members of the diabetes team involved in local ADA and JDF activities? You can call the local offices of each organization, and find out who is involved with these volunteer organizations: Are the health care professionals participating? Do they attend the meetings and charity events? Are they members of the local Board of Directors? Do they give educational presentations on behalf of the organization?
• Finally, I'd be wary of ratings of "the best" programs if they are based on the research that's done at that facility. Some facilities do lots of excellent research, and yet the care of the patients is by relatively inexperienced trainee physicians with minimal supervision from the professors who are more interested in rat research than in people; contrariwise, other facilities may do little or no research, but are very focused on meeting the needs of their patients.