675-P: Diabetes Care and Education Specialists: Opportunities to Improve Glycemia in Disadvantaged Communities

Abstract

The number of people with DM continues to increase, with an inverse proportion of providers and specialists available to provide comprehensive care and support. This is especially troublesome for those at highest risk in underserved areas. Diabetes self-management education and support (DSMES) are critical to achieving quality outcomes. Yet reports show that patients are not participating in traditional DSMES approaches, subsequently DSMES programs are at risk of closure. In response, diabetes educators (DEs), now referred to as Diabetes Care and Education Specialists, are seeking new opportunities to provide services that include attention to behavioral and psychosocial issues. A coordinated care (CC) model was organized to address complex needs of those with DM in a disadvantaged community. The local endocrinologist sought assistance from a hospital-based program to provide coordinated care and DSMES on established clinic days. The DE was available for ongoing follow up and liaising to community services. Overarching goal was to lower mean A1C <8%. Of 80 patients who received care in the DM clinic, majority with type 2 DM (80%) 52.5% F, mean age 57.1±14.1 years, BMI of 34.1 49±10.4 kg/m2 and A1C 9.2%, 49 patients agreed to participate in the CC program while 31 patients received usual care (UC) (traditional visit with endocrinologist only). No statistical differences were found in age, sex, BMI, or mean A1C between groups at baseline. Percent of patients with A1C <8% in CC as compared to UC was 26.5% vs. 29% at baseline (p=0.8); 65% vs. 61.5% at 3 months (p>0.99), 59.3% vs27.8% at 6months(p=0.07); 66.7% vs. 35% at 12 months (p=0.03). The majority of patients in the CC group, maintained lower A1C levels, meeting the immediate target of <8%, while the UC group experienced a consistent rise in A1C over the course of the intervention. A provider-DE model offers a framework for providers and DEs to help a population of patients with complex needs to reach and sustain improved glycemia. Disclosure S. Mon: None. N. Mehrotra: None. D. Ren: None. C. DeJesus: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company.