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

Would a combination MBSR and CT intervention be successful for adults with Type II diabetes who have persistently high A1C levels despite being on insulin?

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:

Care as usual vs addition of MBSR/CT component while decreasing oral and injectible medications.

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.)

Adults diagnosed with Type II diabetes who have progressed from oral medication to injectible without achieving optimal A1C levels.

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

Yes, those patients who start insulin and do not achieve optimal A1C levels in the first six months in introduction for injectible.

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

Decrease in A1C to prevent long term complications from chronic high blood glucose.

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

None

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
• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• 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

Importance

Describe why this topic is important.

Disability and long term medical costs from poor A1C control. The current epidemic in this country of Type II diabetes.

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 am working to develop a clinical guideline for the unfortunate reality that medication is the first line for Type II treatment while we are aware that it isn't a long term solution for most. I have been working from my case conceptulatization of the functionality of the high blood sugar levels based on the person's anxious and driven temperment. Utilizing behavioral health interventions with my patients in this way I have seen significant achievements for my patients with A1C levels and decreasing reliance on medication.

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.)

yes

If yes, please explain:

Human time is expensive and it is easier to prescribe then to reframe and retrain the mind. It also takes skills to understand the concept from a integrative framework. My undergraduate is in clinical nutrition and my first graduate degree is in counseling psychology. It is the true combination of science and art to help the patient achieve prudent goals. I am currently working on my Doctorate in Behavioral Health and believe the Art(Counseling) and Science (clinical nutrition) are necessary to achieve the outcomes for people with Type II diabetes.

Potential Impact

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

I believe what is working for me in my current practice can be taught to more to achieve better outcomes and medical cost offsets.

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

Type II diabetes is epidemic and dissemination of interventions that are evidence based is necessary immediately.

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

Lack of knowledge and dependency on the system to "fix" the individual leaves adults vulnerable and dependent. Too many Americans are dependent on the system...behavioral education is crucial to independence.

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)

I believe what is working for me in my current practice can be taught to more to achieve better outcomes and medical cost offsets.

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