Five Critical Data Points to Collect in Diabetes
Optimal medical therapy (OMT) is a product that is defined by concurrent achievement of five quality measures for diabetes. Minnesota measures these five variables for medical provider groups and reports them to the public. I am aware of no other state that does that. The best care is the least expensive care. Notice that Medicare costs in Minnesota are a fraction of what they are in other states. The percentage of patients who achieve OMT using our protocol will determine how well we do with our clinical and financial outcomes. Here are the defining variables.
Accepted Goals for Comparison with Other Clinics
Diabetes (D5)
1. Blood pressure 140/90 or less
2. LDL cholesterol of 100 or less or on statin
3. Hemoglobin A1c of 8 or less
4. On aspirin if CKD, or known vascular disease
5. Not smoking.
Goals for Maximum Benefit on Clinical and Financial Outcomes
1. Blood pressure 130/80 or less
2. LDL cholesterol of 100 or less or on statin
3. Hemoglobin A1c of 7 or less
4. On aspirin if CKD, or known vascular disease
5. Not smoking.
Using These Medications to Achieve OMT Produces Even Better Outcomes
ACE or ARB, thiazide diuretic, amlodipine, and/or spironolactone or eplerenone for hypertension
Statin for cholesterol or high-risk status (all of our high risk conditions)
Metformin for diabetes. SGLT2 inhibitor preferred second drug (GLP-1 alternate)
These are the most powerful measures you can use. In usual care, OMT is achieved in about 20% of patients across the country. In Minnesota, many clinics triple that performance. To achieve much better performance like that, you must be doing everything else that matters. You are engaging patients. You are using best practice protocols. You are teaching patients about their disease and teaching them how to manage it themselves. You are knocking down barriers and helping with their mental health. These five quality measures tell you all you need to know and how you can improve.
These secondary measures must be coupled with primary lifestyle optimization prevention measures to achieve much better outcomes. Bar none!