• James L. Rosenzweig, MD, is senior director, clinical consulting, at RTI Health Solutions. Before joining RTI, James was the director of diabetes services and associate professor of medicine at Boston University School of Medicine, where he led clinical programs for patients with diabetes at the Boston Medical Center and its affiliated community centers.

    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.

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