Abstract
BackgroundTo evaluate the impact of integrating diabetes education teams in primary care on glycemic control, lipid, and blood-pressure management in type 2 diabetes patients.MethodsA historical cohort design was used to assess the integration of teams comprising nurse and dietitian educators in 11 Ontario primary-care sites, which delivered individualized self-management education. Of the 771 adult patients with A1C ≥ 7% recruited, 487 patients attended appointments with the diabetes teams, while the remaining 284 patients did not. The intervention’s primary goal was to increase the proportion of patients with A1C ≤7%. Secondary goals were to reduce mean A1C, low-density lipoprotein, total cholesterol-high density lipoprotein, and diastolic and systolic blood pressure, as recommended by clinical-practice guidelines.ResultsAfter 12 months, a higher proportion of intervention-group patients reached the target for A1C, compared with the control group. Mean A1C levels fell significantly among all patients, but the mean reduction was larger for the intervention group than the control group. Although more intervention-group patients reached targets for all clinical outcomes, the between-group differences were not statistically significant, except for A1C.ConclusionsNurse and dietitian diabetes-education teams can have a clinically meaningful impact on patients’ ability to meet recommended A1C targets. Given the study’s historical cohort design, results are generalizable and applicable to day-to-day primary-care practice. Longer follow-up studies are needed to investigate whether the positive outcomes of the intervention are sustainable.
Highlights
To evaluate the impact of integrating diabetes education teams in primary care on glycemic control, lipid, and blood-pressure management in type 2 diabetes patients
To address the above-described gaps in the literature, we evaluated the integration of diabetes-education teams in primary care by measuring its impact on several clinical targets for the management of diabetes: A1C, diastolic blood pressure (DBP), systolic blood pressure (SBP), lowdensity lipoprotein cholesterol (LDL-C), and the ratio between total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C)
We found greater effect size for the intervention group on all clinical outcomes compared to the control group, it was only significantly greater for A1C
Summary
To evaluate the impact of integrating diabetes education teams in primary care on glycemic control, lipid, and blood-pressure management in type 2 diabetes patients. In Canada, diabetes self-management education (DSME) and support services are underutilized with uptake of only 25–30% of Canadians living with type 2 diabetes [1]. Most Canadians with diabetes receive care solely from their primary care providers (PCPs) [7], who note challenges in providing optimal diabetes care and self-management support [1, 5, 8]. Fewer than half of Canadians achieve and maintain the recommended clinical targets for diabetes management, covering glycemic control, blood pressure, and lipids [7, 9]. International studies show that 30–70% of patients with type 2 diabetes in primary care settings are not at target [10].
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