- An insurer-based intervention in which high-risk patients with diabetes mellitus (DM) are preidentified, referred for diabetes self-management education and support (DSMES), and receive coordinated ongoing team-based support can improve glycemic control in primary care (PC) settings.
Why this matters
- Most diabetes care takes place in PC settings.
- 2 diabetes educators were introduced as members of PC teams and worked with practice-based care managers to identify and refer DM patients considered at high risk because of HbA1c >9%, DM-related emergency room visit or hospitalization, or reported barriers to care.
- Intervention included evidence-based elements: DSMES, population management, and coordinated patient-centered team-based PC.
- Funding: None.
- Among 108 and 80 patients with available 6- and 12-month data, respectively, HbA1c decreased on average by 1.2% (95% CI, 0.8-1.5) from 9.6% to 8.4% over 6 months and by 1.1% (0.7-1.5) from 9.2% to 8.1% over 12 months (P<.001>
- Significant glycemic outcome improvement was maintained for 1 year postintervention.
- Average low-density lipoprotein-cholesterol decreased by 11.9 mg/dL (2.2-21.7) from 107.5 to 95.5 at 9 months (P=.02), but significance was lost at 12 months.
- No significant change in BMI.
- No control group.
- No evaluation of other factors potentially influencing outcomes.