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Am Fam Physician. 2005;71(8):1612

Improving the Quality of Care for Adults with Type 2 Diabetes Mellitus

The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services has released a technical review on improving the quality of health care for adult patients with type 2 diabetes mellitus. “Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Volume 2—Diabetes Mellitus Care” was released in September 2004 as AHRQ Publication No. 04-0051-2 and is available online at

Diabetes affects more than 17 million people in the United States, and, factoring in undiagnosed cases of diabetes and impaired glucose tolerance, one in seven Americans either has diabetes or is at high risk for developing it. According to the authors, the quality of care for patients with diabetes is less than optimal because many of these patients are not receiving established processes of care (e.g., eye and foot screening) or achieving optimal outcomes (e.g., controlled hemoglobin A1C levels).

The researchers searched the MEDLINE database, the Cochrane Collaboration's Effective Practice and Organisation of Care registry, article bibliographies, and relevant journals for experimental evaluation of quality-improvement interventions in the outpatient care of adults with type 2 diabetes mellitus.

Quality-improvement targets included measures of disease control (e.g., serum A1C levels, blood pressure) and physician adherence (e.g., serial monitoring of A1C levels, control of hypertension, management of cardiovascular risk factors). The researchers found 58 articles reporting a total of 66 trials that met the established inclusion criteria. The most common quality-improvement interventions tested in these studies were organizational change (40 trials), patient education (28 trials), and physician education (24 trials). Fifty-two trials involved interventions that used more than one quality-improvement strategy.

The researchers did not find any strategy to be unambiguously beneficial in the care of patients with diabetes. The physician-education strategy produced large median effects for glycemic control and physician adherence, but the findings were of only borderline significance. Interventions that used case- or disease-management strategies resulted in significantly greater median reductions in serum A1C levels compared with interventions that lacked a component of disease management; however, this trend did not reach statistical significance. All of the other quality-improvement strategies that were evaluated failed to improve serum A1C levels or physician adherence to an appreciable extent. In the larger randomized trials, employing more than one quality-improvement strategy appeared to be more beneficial than single-faceted interventions; however, the small number of studies limits the reliability of this finding.

Overall, the review found that multifaceted interventions may be more likely than single-faceted interventions to have positive effects on glycemic control and physician adherence. However, the conclusions are limited by probable publication bias favoring smaller trials and nonrandomized trials, and the presence of multiple quality-improvement strategies in a given intervention.

ACS Releases 2005 Edition of Cancer Facts & Figures

The American Cancer Society (ACS) released the 2005 edition of its annual publication, Cancer Facts & Figures, which provides a concise summary of the most frequently used cancer statistics, estimates of new cancer diagnoses and deaths for the current year, and national and state data on incidence, mortality, survival, and cancer risk factors. The report is available on the American Cancer Society Web site at

This year's edition also features a special section on cancers caused by infectious disease. The report estimates that in 2005, 17 percent of new cancer diagnoses worldwide will be attributable to infection. These figures include 5 million diagnoses (26 percent of new cases) in developing countries and 360,000 diagnoses (7.3 percent of new cases) in developed countries.

Other statistics include:

  • In 2005, an estimated 1,372,910 new cancer diagnoses and approximately 570,280 cancer deaths (1,500 per day) are expected in the United States, where cancer causes one out of every four deaths.

  • Lung cancer remains the number one cause of cancer death in the United States, with an estimated 171,900 new diagnoses and 163,510 deaths expected in 2005; incidence and death rates from lung cancer continue to decrease in men and decreased for the first time in women from 1998 to 2001.

  • The five-year survival rate for all cancers is now 64 percent, up from 50 percent in the 1970s.

  • The death rate from cancer among black men is about 1.4 times higher than that of white men. For black women, the death rate is 1.2 times higher than that of white women.

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