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Evaluation of a diabetes specialist-guided primary care diabetes treatment program.
J Am Acad Nurse Pract. 2009 Jan; 21(1):24-30.JA

Abstract

PURPOSE

An initial pilot program demonstrated promising results in improvements in glycosylated hemoglobin (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP) and prompted us to test these findings in a controlled trial. The purpose of the Diabetes-focused, Algorithm-directed care, Midlevel practitioner-administered, Electronically coached, Treatment (DAMET-2) program clinical trial was to investigate the benefits of a novel program for disseminating guidance in the treatment of diabetes from a central specialist clinic to primary care centers with access to midlevel provider services.

DATA SOURCES

DAMET-2 included standardized treatment algorithms and education disseminated through computer-assisted and traditional methods associated with distance medicine. Two primary care practices were selected and subjects with diagnosed type 2 diabetes > or =6 months, > or =18 years of age with one or more cardiovascular risk factors (identified by chart review) were eligible for inclusion. Midlevel practitioners for subjects in the experimental group (N = 34) received training in American Diabetes Association treatment algorithms, had telephone consultations at 2- to 4-week intervals and bimonthly visits with diabetes specialists, and received treatment guidance within 24 h from remote diabetes specialists. Weekly diabetes clinics were made available to subjects in the experimental group. After 12 months, the last available subject data were extracted from the subjects' charts and compared to 12-month chart data from a control group (N = 101) that did not receive additional study services.

CONCLUSIONS

Mean HbA(1c) values decreased from baseline by 0.46% in the active treatment group versus 0.06% in the control group; however, reductions in HbA(1c) did not achieve statistical significance potentially because of the small sample size of the experimental group. Mean SBP values were significantly reduced in both groups; however, LDL-C was only significantly reduced in the control group, where more aggressive use of statins may have had an effect.

IMPLICATIONS FOR PRACTICE

Despite the inconsistencies in risk factor reduction from the pilot program, the DAMET-2 program provided insights regarding the importance of electronic records and provider notifications, patient adherence, prioritization of provider resources by risk factor level among patients, and access to self-management education.

Authors+Show Affiliations

Diabetes Care Center, Salinas, CA 93901, USA.No affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19125892

Citation

King, Allen B., and Gary S. Wolfe. "Evaluation of a Diabetes Specialist-guided Primary Care Diabetes Treatment Program." Journal of the American Academy of Nurse Practitioners, vol. 21, no. 1, 2009, pp. 24-30.
King AB, Wolfe GS. Evaluation of a diabetes specialist-guided primary care diabetes treatment program. J Am Acad Nurse Pract. 2009;21(1):24-30.
King, A. B., & Wolfe, G. S. (2009). Evaluation of a diabetes specialist-guided primary care diabetes treatment program. Journal of the American Academy of Nurse Practitioners, 21(1), 24-30. https://doi.org/10.1111/j.1745-7599.2008.00370.x
King AB, Wolfe GS. Evaluation of a Diabetes Specialist-guided Primary Care Diabetes Treatment Program. J Am Acad Nurse Pract. 2009;21(1):24-30. PubMed PMID: 19125892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of a diabetes specialist-guided primary care diabetes treatment program. AU - King,Allen B, AU - Wolfe,Gary S, PY - 2009/1/8/entrez PY - 2009/1/8/pubmed PY - 2009/5/2/medline SP - 24 EP - 30 JF - Journal of the American Academy of Nurse Practitioners JO - J Am Acad Nurse Pract VL - 21 IS - 1 N2 - PURPOSE: An initial pilot program demonstrated promising results in improvements in glycosylated hemoglobin (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP) and prompted us to test these findings in a controlled trial. The purpose of the Diabetes-focused, Algorithm-directed care, Midlevel practitioner-administered, Electronically coached, Treatment (DAMET-2) program clinical trial was to investigate the benefits of a novel program for disseminating guidance in the treatment of diabetes from a central specialist clinic to primary care centers with access to midlevel provider services. DATA SOURCES: DAMET-2 included standardized treatment algorithms and education disseminated through computer-assisted and traditional methods associated with distance medicine. Two primary care practices were selected and subjects with diagnosed type 2 diabetes > or =6 months, > or =18 years of age with one or more cardiovascular risk factors (identified by chart review) were eligible for inclusion. Midlevel practitioners for subjects in the experimental group (N = 34) received training in American Diabetes Association treatment algorithms, had telephone consultations at 2- to 4-week intervals and bimonthly visits with diabetes specialists, and received treatment guidance within 24 h from remote diabetes specialists. Weekly diabetes clinics were made available to subjects in the experimental group. After 12 months, the last available subject data were extracted from the subjects' charts and compared to 12-month chart data from a control group (N = 101) that did not receive additional study services. CONCLUSIONS: Mean HbA(1c) values decreased from baseline by 0.46% in the active treatment group versus 0.06% in the control group; however, reductions in HbA(1c) did not achieve statistical significance potentially because of the small sample size of the experimental group. Mean SBP values were significantly reduced in both groups; however, LDL-C was only significantly reduced in the control group, where more aggressive use of statins may have had an effect. IMPLICATIONS FOR PRACTICE: Despite the inconsistencies in risk factor reduction from the pilot program, the DAMET-2 program provided insights regarding the importance of electronic records and provider notifications, patient adherence, prioritization of provider resources by risk factor level among patients, and access to self-management education. SN - 1745-7599 UR - https://www.unboundmedicine.com/medline/citation/19125892/Evaluation_of_a_diabetes_specialist_guided_primary_care_diabetes_treatment_program_ L2 - https://doi.org/10.1111/j.1745-7599.2008.00370.x DB - PRIME DP - Unbound Medicine ER -