What works? The Diabetes Care and Information Center

This report focuses on the contribution of a referral practice that offers specialist diabetes care to a multi-ethnic population in New York, and describes the process and outcome of an intensive management policy that is particularly strong on communication. The Diabetes Care and Information Center (DCIC), which practices shared care with local primary care physicians, has developed a programme of intensive management for Type 1 and Type 2 diabetes based on a detailed initial patient assessment by a physician, nurse-educator and dietician team. The assessment is followed by an individualized programme of patient education that includes a combination of individual and group education, and counselling. Patients are followed up primarily by an educator or a physician, with frequent interdisciplinary communication to optimize self-care procedures. Medication programmes for patients with Type 2 diabetes include monotherapy and combination therapy with oral agents and single or multiple doses of insulin. Metabolic improvement has been demonstrated by significant changes in mean HbA1c. In addition to initial assessment and routine metabolic follow up, the DCIC provides routine screening and treatment for micro- and macrovascular complications of diabetes, which results in early referral to podiatrists, vascular surgeons and ophthalmologists for appropriate preventive care.