Abstract
BackgroundBoth primary care practices based on the chronic care model (CCM) and digital therapeutics have been shown to improve the care of patients with diabetes.ObjectiveThe aim of this observational study was to examine the change in diabetes control for patients enrolled in a membership-based primary care service that is based on the CCM.MethodsUsing a diabetes registry, we analyzed the change in glycated hemoglobin (HbA1c) for patients with uncontrolled diabetes mellitus (initial HbA1c≥9%). All patients had access to a technology-enhanced primary care practice built on the CCM.ResultsThe registry included 621 patients diagnosed with uncontrolled diabetes. All patients had at least two HbA1c measurements, with the average time between the first and last measurement of 1.2 years (SD 0.4). The average starting value of HbA1c was 10.7, which decreased to 8.7, corresponding to a reduction of 2.03 (P<.001). Secondary analyses showed statistically significant reductions in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides.ConclusionsPatients with initially uncontrolled diabetes who undergo care in a technology-enhanced primary care practice based on the CCM have long-term clinically meaningful reductions in HbA1c.
Highlights
Uncontrolled diabetes mellitus (DM) has serious complications, including increasing the risk for heart disease, peripheral vascular disease, and kidney disease [1]
The chronic care model (CCM) comprises 6 components that are hypothesized to affect functional and clinical outcomes associated with disease management: (1) health system—organization of health care, (2) self-management support, (3) decision support, (4) delivery system design, (5) clinical information systems, and (6) community resources and policies
The analysis included a dataset for 621 patients (8% of the registry of 7805 patients) who met our inclusion criteria as their diabetes was uncontrolled upon presentation
Summary
Uncontrolled diabetes mellitus (DM) has serious complications, including increasing the risk for heart disease, peripheral vascular disease, and kidney disease [1]. Most patients with DM are treated in primary care [2]; yet, traditional models of primary care often do not have the adequate resources to manage this chronic disease. The chronic care model (CCM) has been described as a way for primary care practices to control chronic diseases, including diabetes [3,4]. The practice is a Patient-Centered Medical Home, as it is built on the core attributes of primary care, along with enhanced access, a quality-improvement structure, and some https://diabetes.jmir.org/2021/2/e27453. Both primary care practices based on the chronic care model (CCM) and digital therapeutics have been shown to improve the care of patients with diabetes
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