The Effects of Disease Management on Glycemic Control and Adherence to American Diabetes Association Guidelines in an Air Force Population

Abstract

Abstract : Diabetes has a profound and widespread effect on the medical and financial well-being of this country. Healthcare providers are not always aware of, nor do they always comply with the American Diabetes Association's (ADA) published practice guidelines for diabetic care. To improve patient care, the United States Air Force, as well as many civilian medical care facilities, have implemented a primary care approach to diabetes care based upon continuous quality improvement principles called Disease Management. This quasi-experimental study employed a pre/post-intervention design to compare the effectiveness of traditional primary care with disease management care in achieving glycemic control and adherence to American Diabetes Association guidelines in 28 type 1 and type 2 diabetes patients at an Air Force family medicine clinic. Content validity testing on the study instrument designed for this study showed a content validity index of 0.95. There was a high degree of correlation on intra-rater and inter-rater reliability tests of the instrument. Non-significant improvements in glycemic control were found in disease management care compared with traditional care. Disease management improved compliance in all 18 adherence to ADA guideline indicators studied, with significant improvements in nutritional assessment 25.0% (p = 0.009), exercise addressed 26.8% (p = 0.006), annual foot exams 39.3% (p = 0.001), annual urine microalbumin screening 32.1% (p = 0.004), annual lipid screening 28.5% (p = 0.02), comprehensive diabetes education 28.6% (p = 0.008), baseline EKG 42.8% (p < 0.001), and tobacco and alcohol assessment 33.9% (p < 0.001). Study findings add to the current body of nursing knowledge regarding diabetes care.