Self-management of Chronic DiseaseSelf-management of Chronic Disease

To the Editor: Dr Bodenheimer and colleagues¹ described a "collaborative care program for chronic disease management." The authors proposed increased "self-management education" as a central feature of their program. Unfortunately, this intervention is limited in scope and ignored a comprehensive systems-approach that has proven to be innovative and effective. For instance, the Diabetes Control and Complications Trial succeeded in decreasing and sustaining a significantly lowered hemoglobin A_1c level during the 10-year duration of the trial.²