Role of Clinical Practice Guidelines in the Management of Diabetes and Diabetes-Related Complications

John A. Johnson, MD, MBA: Most commercial and government-sponsored health plans have what are called clinical practice guidelines. These are evidence-based guidelines that we [WellCare] publish and make available. We have one for diabetes management. These are guidelines that are aids to assist clinicians with managing their diabetics. They’re evidence-based. They’ve shown [to be] proven approaches to managing diabetics, and we make these are available to our providers to ensure that they have up-to-date information.

The managed care community is responsible for partnering with providers and partnering with the members we serve to ensure that their care gaps (their performance measures or quality gaps) are closed—whether it be A1C (glycated hemoglobin), how frequently their A1C should be checked, and then what’s considered [the] goal for hemoglobin A1C.

As you know, if you check with the American Diabetes Association, an A1C below 7.0% is considered goal. However, the American Association of Clinical Endocrinologists says below 6.5%. So, what we advocate [for] is to try to get the A1C as low as you can without causing risk of hypoglycemia, which can be quite fatal.

At WellCare, we make this information available to our members and our clinicians so that they’re aware of the recommended items of care that should be done. Another thing we make available are the diabetic retinal eye exams. We partner with a lot of our vendors to make diabetic retinal eye exams a priority for our diabetics because we’ve seen that with the onset of diabetic retinopathy, you’re at risk for blindness. Management of blindness in the Medicare/Medicaid population can be quite costly, so getting a preventative diabetic retinal screening annually can help ensure that diabetic retinopathy has not progressed.