Outcomes in an Interdisciplinary Diabetes Clinic in Rural Primary Care
AbstractObjective: The purpose of this study was to evaluate the effectiveness of an interdisciplinary diabetes team model of care in assisting patients to achieve improved glucose control in a primary care rural setting.
Methods: A family medicine clinic at a rural university medical center developed an interdisciplinary diabetes team clinic composed of a certified diabetes educator/dietitian, a case manager, a pharmacist, nursing staff, a family medicine resident, a psychologist, and a board-certified family medicine attending physician. Patients were referred if their hemoglobin A1c (HbA1c) was ≥9% (75 mmol/mol); patients were seen for an initial consultation and for additional visits as needed.
Results: A total of 94 patients attended an initial visit and at least 1 follow-up within 6 months. Mean age was 57 ± 13 years, and 54% were female. Median time from the initial intensive diabetes clinic visit to a follow-up visit was 2.8 months. There was a significant reduction in median HbA1c percentage from 10.25% (88.5 mmol/mol) ± 1.4% (range 73–104 mmol/mol) at the initial intensive diabetes clinic visit to 8.7% (72 mmol/mol) ± 1.8% (range 52–92 mmol/mol) at a 1- to 6-month follow-up (z = −7.161, P < 0.001) and a significant difference between baseline HbA1c (10.25% [88.5 mmol/mol] ± 1.4% [range 73–104 mmol/mol]) and latest HBA1c (1–18 months later) 8.4% (68 mmol/mol) ± 2.2% (range 44–92 mmol/mol; z = −7.022, P < 0.001). Overall, 86% of patients had a lower HbA1c at follow-up, and 33% had an HbA1c <8% (64 mmol/mol). There were no differences in patients’ blood pressure, immunization rates, or lipid values between baseline and follow-up visits (P > 0.05).
Conclusions: An interdisciplinary team approach to glycemic control can achieve significant reductions in HbA1c in the rural primary care setting.
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