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CDEs improve patient health in primary care
BOSTON — Certified diabetes educators integrated into primary care and using a patient-centered practice model improved HbA1c, lipid and blood pressure levels in patients with the worst glycemic control, according to research presented here.
Linda M. Siminerio, RN, PhD, CDE, professor of medicine in the University of Pittsburgh Diabetes Institute, and colleagues, conducted a feasibility study to assess the effect on patient glycemic control of a model for delivery of diabetes education that includes implementing CDEs in primary care.
Linda M. Siminerio
Researchers provided a certified diabetes educator (CDE) to a primary care practice in an urban, a suburban and a rural setting. CDEs used the practices’ electronic health records to identify patients for targeted education and then worked collaboratively with primary care providers on treatment plans.
CDEs met with 143 patients with type 2 diabetes (61.3 ± 12.4 years, 51% men, BMI 35.9 ± 0.7 kg/m2), who were stratified by their HbA1c levels, recorded 1 to 3 months prior to the beginning of the study, into groups with levels below 7% (n = 30), between 7% and 9% (n = 41), and above 9% (n = 40); 78% of the patients had this information available in the electronic record. These records were compared with HbA1c levels at 3 to 6 months and 9 to 12 months after the first visit with the CDE. CDEs also tracked blood pressure, weight, height and lipid values.
Patients in the below 7% group maintained this level at the 3- to 6-month visit, but mean HbA1c levels increased significantly by the 9- to 12-month visit (+0.4 ± 0.8; P < .05). This increase could be the result of disease trajectory or treatment, Siminerio said during her presentation.
Those in the mid-level group had a significantly reduced mean HbA1c level at 3 to 6 months (-0.5 ± 1.1%; P < .01), but this level was increasing by 9 to 12 months. The group with the highest baseline levels saw a significant mean reduction in HbA1c at 3 to 6 months (-2.3 ± 2.1%; P < .001), which was maintained at 9 to 12 months (-2.2 ± 2.2; P < .001).
Overall, significant improvements were seen in triglyceride and total cholesterol levels and in systolic blood pressure from the first CDE visit to 1 year after program completion.
Siminerio credited the program’s success to the team dynamics between CDEs and primary care staff. “Our educators who are in the practice, once that trust was developed between the educator and the [primary care provider], the educators were penning orders or recommendations to say, ‘This patient is ready to start insulin’ or ‘This patient is not doing well with this particular medication.’ There was a great communication,” she said.
Primary care providers were able to share their workload and, together with improved patient health, this translates into savings and incentives for practices, Siminerio said. “However, we recognize that further studies are needed to assess long-term effectiveness.” – by Jill Rollet
Reference:
Siminerio LM, et al. Abstract 210-OR. Presented at: American Diabetes Association’s 75th Scientific Sessions; June 5-9, 2015; Boston.
Disclosure: Siminerio reports research support from Becton, Dickinson and Company.