Because diabetes is a complex disease, it can be very difficult to manage. For people to manage the disease successfully, many different issues must be monitored and controlled. By combining key treatment goals into the D5, it’s possible to provide an overall picture of how well a person’s diabetes is being managed.

The D5 was created to make it easier for people with diabetes and their healthcare providers to focus on the issues that have the greatest health impact. People who achieve their goals on the D5 greatly reduce their risk of heart attacks, blood vessel damage and other cardiovascular diseases. They will also experience fewer problems with their kidneys, eyes and nervous system. Heart disease and stroke are the leading causes of early death among people with diabetes, and yet not everyone is focused on the factors that pose the greatest risks (see sidebar).

The D5 reports on how well clinics are helping their patients with diabetes manage these five risk factors. One goal of this reporting is to help health care providers improve their systems for working with patients. But success in achieving the D5 clearly depends on a strong partnership between patients and their providers. People with diabetes should know that the D5 is the gold standard of diabetes management. Setting and achieving these goals depends on people taking an active role in their health care and working with their providers to make sure they are getting the best care possible.



D5 data is collected from clinics in and around Minnesota by medical record review, practice management systems or electronic health records.

The D5 is a composite measure of five treatment goals for the prevention of cardiovascular conditions. The measure is based on an "all or nothing" concept, meaning that only those patients achieving all five treatment goals count towards a clinic's D5 percentage.

The data is based on adult patients who have type 1 or type 2 diabetes. Included in the D5 measure are established patients, ages 18-75 (as of December 31 of the measurement year 2007), with a diabetes diagnosis meeting all of the following criteria:

• Patient was seen at least two times in the past two years for the diagnosis;

• Diagnosed with diabetes defined as ICD_9 diagnosis code 250.xx;

• Seen by one of these provider types: Endocrinology, Family Practice, General Practice, Geriatric Medicine, Internal Medicine, Pediatric Medicine, Physician Assistant, or Nurse Practitioner.


The following describes how the five components of the D5 measure are determined. In order to be counted toward a clinic's D5 percentage, a patient must have met all five components:

1: Blood Pressure Control
Documentation of a blood pressure reading from an office visit in the measurement year. Home monitored blood pressure readings or those related to diagnostic or surgical procedures are not counted. The most recent blood pressure reading from an office visit had a systolic value of less than 130 and diastolic of less than 80. If there were multiple readings from the same date, the lowest systolic and the lowest diastolic may be used.

2: LDL-C Control
An LDL cholesterol test was performed in the measurement year and the most recent LDL value was less than 100 mg/dL.

3: HbA1c Control
An HbA1c test was performed during the measurement year and the most recent HbA1c value was less than 7%.

4: Documented Tobacco Free
Documentation of tobacco use status was in the medical record and the patient was documented as tobacco free. Tobacco includes cigarettes, cigars, pipes, or "chew".

5: Daily Aspirin Use For patients ages 41-75 during the measurement year, documented daily aspirin use or a documented accepted contraindication. Other acceptable medications include: Plavix (Clopidogrel), Ticlid (Ticlopidine), low dose enteric-coated 81 mg ASA (Ecotrin or Bayer), and Aggrenox (ASA & Dypyridamole)

To collect the data, MN Community Measurement (MNCM) gave medical groups a protocol on how to identify the appropriate diabetes patients. Medical groups were required to report data to MNCM for each clinic site where care was provided. Medical groups decided whether to send full population data or a sample by clinic site. For medical groups that submitted a sample, data submission guidelines were given on how to select a systematic, random sample for each site. To ensure a statistically significant sample, medical groups were required to submit results for a minimum of 100 patients per clinic site (or their entire population if the clinic had fewer than 100 patients).

The data was securely submitted to MNCM and stored in a manner that complies with all state and federal laws governing patient confidentiality and privacy. Upon receipt of medical group data, MN Community Measurement conducted an independent audit of the data to ensure the validity of the results.