Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What are the best practice Behavioral Health programs for type 1 diabetes, type 2 diabetes and gestational diabetes. Does educational counseling help paitients improve control and adherence to treatment?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

All existing diabetes treatment modalities and behavioral intervention types. http://www.drugs.com/diabetes-treatment.html

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Children and adolescents with type 1 or type 2 diabbetes. Adults with type one or two diabetes.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Yes. Newly diagnosed (within the last year). Those with history of good to excellent control as measured by a1c of less than 7 vs those with poor control - those with a1c above 7.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improved glycemic control. Improved quality of life. Increased excercise and healthy diet. Decrease of Depression, Anxiety.

Describe any health-related risks, side effects, or harms that you are concerned about.

Hypoglycemia, Hyperglycemia, Ketoacidosis, Death due to severe hypoglycemia or coma and death due to hyperglycemia. Depression. Anxiety.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders
• Diabetes mellitus

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

The Centers for Disease Control indicate that diabetes is an epedemic. The consequences of poor control of diabetes is increased health costs, suffering, complications such as heart disease, hypothyroidism, amputations, kidney failure, blindness and premature death.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I have lived with type 1 diabetes successfully with excellent control for 39 years and I am a counselor worning in a community health agency. I recently noted that public health clinics were measured as having poor results with patients diabetes control. We offer a "Healthy Living with Chronic Conditions" class and I beleive intensive wholeistic care for all paitients with diabetes would reap many benifits in decresing long term costs and negetivity associated with living with diabetes.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

no

If yes, please explain:

Not sure.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will provide a standard of care or best practice that could be replicated in community health centers accross the nation to improve diabetes control.

Describe the timeframe in which an answer to your question is needed.

One to three years.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Many vunerable populations srtruggle with diabetes care.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will provide a standard of care or best practice that could be replicated in community health centers accross the nation to improve diabetes control.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program