Improving glycemic control in adults with diabetes mellitus: Shared responsibility in primary care practices

• Published in: Southern medical journal (Birmingham, Ala.) Vol. 95; no. 7; pp. 684 - 690
• Main Authors: GRABER, Alan L, ELASY, Tom A, QUINN, Doris, WOLFF, Kathleen, BROWN, Anne
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.2002
• Subjects: Adult; Biological and medical sciences; Diabetes Complications; Diabetes Mellitus - blood; Diabetes Mellitus - nursing; Diabetes Mellitus - therapy; Diet, Diabetic; Endocrinology; Female; Glycated Hemoglobin A - analysis; Humans; Hyperglycemia - prevention & control; Hypoglycemia - prevention & control; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Outcome and Process Assessment (Health Care); Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patient Care Team - standards; Patient Compliance; Patient Education as Topic; Physicians, Family; Program Evaluation; Referral and Consultation; Regression Analysis; Self Care; Endocrinopathy; Human; Biochemical analysis; General practitioner; Primary health care; Diabetes mellitus; Check; Biology; Prevention; Information communication; Adult; Complication; Occupational responsibility; Medical specialty; Glycemia
• ISSN: 0038-4348; 1541-8243
• DOI: 10.1097/00007611-200207000-00007

Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications Primary care physicians referred patients with unsatisfactory glycemic control, frequent hypoglycemia, or inadequate self-management to an endocrinologist-directed team of nurse and dietitian educators for a 3-month program of intensive diabetes care. Patients had at least weekly contact with a diabetes educator and received changes in insulin and/or other medication, coupled with extensive individualized instruction. The main outcome measurement was change in glycosylated hemoglobin (HbA1c) level at 3 months. The first 350 patients who completed the program had overall mean decrease in HbA1c level of 1.7% (95% CI 1.4%-1.9%). Barriers to improving glycemic control may be overcome by establishment of a system of collaboration between primary care providers and endocrinologist-directed diabetes educators.