Synchronous Provider Visit and Self-management Education Improves Glycemic Control in Hispanic Patients With Long-Standing Type 2 Diabetes

Abstract

The purpose of this study was to evaluate the efficacy of a multidisciplinary diabetes self-management program. The study focused on improving diabetes control by synchronizing regularly scheduled provider visits with a multidisciplinary diabetes education program. This intervention was instituted in Hispanic patients with long-standing poorly controlled type 2 diabetes. The study was initiated as a performance improvement project. A group of 44 type 2 diabetes patients followed by the internal medicine faculty with HbA1c levels greater than 9.5 over a 12-month period was identified. Twenty-three of the identified patients were enrolled in a synchronous care group. A cohort control group of the remaining 21 patients not participating in the intervention was followed with routine care. The intervention group shared similar demographic characteristics, medication regimens, initial diabetes control, and a number of provider visits with the control group. The primary outcome of interest for the study is the HbA1c level. The findings demonstrated that our synchronous management approach significantly improved HbA1c level over standard management for medically indigent Hispanic patients with long-standing poorly controlled type 2 diabetes (P < .001). The majority of the patients (89%) in the Intensive Management Group had declines in HbA1c level from baseline, compared to the Standard Management Group (60%, P = .04). The temporal linkage between routine provider visits and a diabetes self-management education intervention in poorly controlled Hispanic patients with long-standing type 2 diabetes led to a significant improvement in HbA1c levels.