An endocrinologist who led the creation of national disease
management guidelines, Dr. Rosenzweig is chair of the Quality Improvement Subcommittee
of the Endocrine Society, an NQF member organization. He has served on
committees to help establish performance measures at the Society and co-chairs
NQF’s Endocrine Standing Committee. NQF spoke with James about recent
findings in the Journal of the
American Medical Association that diabetes prevalence may be plateauing in
the United States.
NQF: Are the recent
findings a hopeful sign?
JR: The prevalence of diabetes seems to be leveling off in
the United States, but it is still increasing in the Hispanic population, and
it’s still very high overall. That said, I’m cautiously optimistic. When
looking at long-term trends we often see plateauing at varying periods, so we
still don’t know for sure that the prevalence has leveled off or is decreasing. It is a good sign, however, that the percentage of undiagnosed diabetes
has decreased, because it’s likely that we’re detecting diabetes earlier.
Treating diabetes in its earlier stages is especially important for preventing
long-term complications.
NQF: Patient engagement is so critical in
managing the care of people with diabetes. How important are patient-reported
outcomes in improving diabetes care and the health of this population?
JR: Patient-reported information is very important in
helping patients to manage their behavior and for early identification of a
complication of diabetes, such as eye disease, kidney disease, and
cardiovascular symptoms. Good communication between providers and patients is
extremely important in diabetes care.
NQF: What’s the next step for measurement
in diabetes care?
JR: Many of the key diabetes measures currently in use are
process measures, such as whether a patient got a hemoglobin A1C test. Looking
ahead, we may see the use of more or different outcome measures, such different
ways of measuring body fat (other than body mass index) as a means of assessing
risk. For example, guidelines that I authored for the Endocrine Society
recommend the measurement of patients’ waist circumference as a surrogate
measure for body fat, because abdominal fat has a metabolic rate that tends to
promote diabetes and cardiovascular disease.
Looking
farther ahead, we’re entering an era in which people can use technology to
monitor their activities in different ways. Data gathered from various devices
may eventually help physicians better manage care for diabetes. For example, a
physician could theoretically examine data on a patient’s physical activity
over time from a device.