Diabetes Education Intervention in an Inner City Ambulatory Clinic

BACKGROUND: 21 million US adults have type II diabetes mellitus (DM), with medical costs at $92 billion. Prevalence of diabetes is higher for African Americans (AA) (13%) and Hispanics (H) (12%) than the white population (8%). Poor DM control is influenced by multiple factors. The DCCT trial demonstrated that lowering blood glucose reduces risk of retinopathy, nephropathy, and neuropathy by 76%, 50%, and 60% respectively. The University Hospital (UH) ambulatory practice serves predominantly minority adults with a DM prevalence of 25-30%.

PURPOSE: This initiative aims to evaluate the effectiveness of an intensive DM management program in poorly controlled diabetics.

METHODS: In 2005, a list of all patients with a diagnosis of DM was obtained from the database of the ambulatory practice, and 800 of those charts were reviewed. Data extracted: HgA1c, lipid panel, blood pressure, BMI. A similar analysis was conducted in 2006, with 300 charts reviewed. In both cases, approximately 30 % of patients had HgA1c greater than 9 %, (poor control). Primary care physicians in the ambulatory care practice refer patients with poor control for diabetes education. The intensive management program consists of: 1) education through group lectures; 2) individual disease management 3) increased visit frequency and 4) increased visit length according to need. Those patients with an HgA1c of 9% or higher are enrolled in this intensive program. As part of the quality improvement initiative of the practice, a retrospective chart review of patients that participated in the intensive program was conducted. For analysis purposes, a subset of 34 patients participating in the program (21 AA and 13 H) who provided at least one pre- HgA1c and several post-intervention HgA1c and lipid measurements were selected.

RESULTS: 76% of total patients showed improvement as demonstrated by a decrease in HgA1c of 2.3±2.5% at the 1st post treatment visit (2.6 months) (p<.001). 71% of total patients showed improvement at the 2nd post-treatment visit (6.0 months)–2.4±2.4% (p<.001).

Similar significant improvements were seen in their lipid profiles. Changes in BMI and blood pressure were not statistically significant. Mean duration of intervention was 2.6±2.7 months with 3±1 visits. This program was tailored to the needs of each patient.

CONCLUSION: The program was beneficial to patients regardless of ethnicity or race as seen by improvement in overall glucose control as measured by HBA1C level. The success can be attributed to the multidisciplinary approach employed in the care of this group of patients.