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The Team Approach to Diabetes: An Idea Whose Time Has Come

During the twentieth century there has been a significant change in the type of disease most prevalent in the United States. This country has left the age of acute disease and entered the age of chronic illness. Since 1900, death rates associated with infectious diseases have been reduced by more than 90%, while death rates associated with chronic illnesses such as cardiovascular disease, cancer, and diabetes have increased substantially.1 The prevalence of diabetes has increased sixfold since the early 1930s. This increase, however, is not due to the increased life expectancy of the population, since from 1958 to 1978 the rate of diabetes has increased much faster for persons under the age of 44 years than for persons 65 years and older. When considered together with its complications, diabetes is estimated to be the th ird leading cause of death by disease in the United States.' During the era of acute disease, the traditional medical model approach to health care was the norm. The traditional approach involved the patient who was passive and uneducated in the treatment and prevention of disease or the maintenance of health. It also involved a physician who was an expert, a decision maker, a problem solver and the one who was respons ible for the treatment of disease and maintenance of health. Health was thought to be the natural Robert M. Anderson, EdD, Director of Education, Diabetes Research and Training Center, University of Virginia Medical Center, Charlottesville.