Mount Sinai Hospital in New York City has entered into a merger with Continuum Health Care which includes three major hospitals in New York City. This will create the largest health care system in the metropolitan area. Each of these institutions play an important role in diabetes via research, clinical, and educational programs. This goes further with the addition of outlying institutions and ambulatory care. Wow. This could be a major opportunity to utilize public health measures to deliver excellent diabetes care to an estimated one half to one million people with diabetes. There are not enough endocrinologists to come close to encountering these patients, who are mostly seen by primary care physicians.
What to do? Here are my suggestions.
This kind of system needs a series of diabetes education and management centers around the metropolitan area. They should be staffed with an assortment of Certified Diabetes Educators, including nurses, nutritionists, psychologist, exercise physiologists, etc. They would be under the management and guidance of a couple of senior diabetes specialists who would make sure the education and function of the staff was at its peak. No practicing endocrinologists would be involved except as a referral source or a referral recipient. The interactions are primarily between patients and educators or primary care physicians. This would allow for centralization and expertise in the technology of insulin delivery and blood glucose monitoring. Second layer activity such as lay facilitators would absorb a portion of the burden. Finally, interaction with the activity programs in NYC would play a major role.
Much of this is accomplished at the Friedman Diabetes Institute at the Beth Israel Medical Center. In the long run, cost savings from early screening for prediabetes, good life style adjustment, and glucose control will result in prevention of cardiovascular and microvascular complications.
Is this reality or fantasy? We will see.