Diabetes: A Primary Health Care Approach

Abstract

With an increasingly older and overweight global population, the public health burden of diabetes mellitus and cardiovascular disease is rapidly growing. Throughout the developed world, primary care providers play the leading role in managing diabetes and its complications. Evidence shows that there is substantial room for improvement in primary, secondary, and tertiary diabetes prevention, and that improving diabetes care requires redesign of health-care delivery systems. These systems should be designed with an actively engaged patient at the center of a proactive, multi-disciplinary, coordinated care team. The Chronic Care Model and Patient-Centered Medical Home are two models which have been used to provide this kind of care. Locally and internationally, policies are needed to: (1) improve access to and training of primary care and diabetes specialists; (2) improve access to self-management education, diabetes supplies, and medications; (3) provide appropriate reimbursement for care coordination and population-based disease management (i.e., electronic health records and diabetes registries); and (4) promote individualized programs to address unique individual determinants of health such as age, race/ethnicity, socioeconomic status, co-morbid medical conditions, and mental illnesses. Primary care providers, through such system-wide reform, will continue to be the champions of their patients’ health and work to ease the burden of the diabetes epidemic.