Quality Improvements to Primary Care Have Not Included Diabetes Ninety percent (90%) of diabetes management is delivered in primary care. Yet quality improvement efforts being implemented in primary care such as population management, electronic communication, and practice redesign have not been fully applied and tested in diabetes education services.
Feasibility Study Incorporated Certified Diabetes Educators into Primary Care Practices
The feasibility study deployed a model that relied on quality improvements to facilitate diabetes education in primary care practices. The impact of these improvements was assessed in terms of patient glycemia. Three certified diabetes educators were introduced into primary care practices in urban, suburban, and rural communities, respectively.
Certified Diabetes Educator Coordinated the Education in Concert with the Primary Care Practitioner
Via the electronic medical record in each practice, the certified diabetes educator identified patients for diabetes education, reviewed these with primary care providers, arranged diabetes education visits, and worked collaboratively with primary care practitioners on treatment plans.
Hemoglobin A1C Levels Were Used To Measure Outcomes
Hemoglobin A1C values were collected 1 to 3 months prior to diabetes education to establish patient glycemic control prior to diabetes education.
Patients were categorized by pre-education hemoglobin A1C levels <7%, >7% to 9%, and >9%. These values were compared to hemoglobin A1C levels at 3-6 and 9-12 months post diabetes education.
Hemoglobin A1C values were available in the electronic medical record for 78% of 143 patients with type 2 diabetes (61.3 ±12.4 years of age, 51% male) who met with a certified diabetes educator.
Hemoglobin A1C Levels Improved or Were Maintained with the Intervention
For patients with pre-education hemoglobin A1C <7% (n=30), pre-education hemoglobin A1C levels were maintained at 3-6 months after the diabetes education, but increased significantly by 9-12 months (+0.4% ± 0.8%; P<.05).
For patients with pre-education hemoglobin A1C >7%- 9% (n=41), hemoglobin A1c was reduced significantly at 3-6 months post education (-0.5 ± 1.1%, P<.01), but trended upward at 9-12 months.
For patients with pre-education hemoglobin A1C >9% (n=40), hemoglobin A1C was significantly reduced between pre-education and 3-6 months after education (-2.3% ± 2.1%; P<.001).
The reductions in hemoglobin A1C were sustained at 9-12 months post diabetes education (-2.2% ± 2.2%; P<.001).
Benefits of Diabetes Education Were Reaffirmed
This primary care approach to diabetes education was shown to be feasible, and the benefits of diabetes education were reaffirmed for all patients with diabetes, particularly those of higher risk. Further research is needed to examine models that integrate diabetes education services in primary care and their effect on maintaining glycemic improvement, on patient access, and on the limiting cost of services.