Primary care model successfully incorporates DM education

  • Zupa MF & al.
  • Diabetes Educ
  • 3 Oct 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.  

Limitations

  • No control group.
  • No evaluation of other factors potentially influencing outcomes.

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