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CDEs add effective diabetes management to primary care
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BOSTON — Certified diabetes educators using evidence-based diabetes management protocols to intensify patient treatment in primary care offices were able to affect significant improvement in patient HbA1c levels, according to data presented at the American Diabetes Association’s 75th Scientific Sessions.
Janice C. Zgibor, RPh, PhD, of the University of Pittsburgh, and colleagues conducted a cluster randomized controlled trial to explore the feasibility and effectiveness of using certified diabetes educators (CDEs) to intensify therapeutic management of patients with diabetes at 15 non-academic primary care practices that did not currently use CDEs. Eight practices were randomly assigned a CDE to provide glucose, cholesterol and blood pressure management, along with diabetes education and follow-up, and seven practices served as a control group. Participating patients had type 2 diabetes for at least 1 year and baseline HbA1c of at least 7%, LDL cholesterol of at least 100 mg/dL or BP of at least 140 mm Hg/80 mm Hg (mean age, 61 years; range, 29-87; 50% men, 83% white).
Janice C. Zgibor
The CDEs followed a set of agreed-upon diabetes management protocols (DMP) and education following ADA standards and were empowered to order medications and lab work, which were marked in the patient electronic health record as “pending” before approval by a physician. Any issues outside of the protocols were referred to the primary care provider.
At the end of the 12-month study period, the patients in the DMP group (n = 175) had a decrease from baseline in HbA1c, from 8.8% to 7.8% (P < .0001); mean HbA1c in the usual care group remained unchanged. Decreases in LDL cholesterol were noted in both groups, significant only in the DMP group, whereas no significant changes in BP were observed.
Of patients with baseline HbA1c of 8% or higher, preliminary results showed that 65% were prescribed a new medication or intensified therapy. CDEs intensified therapy for 63% of patients with LDL cholesterol at least 100 mg/dL: 50% were prescribed a new medication, 16% changed statins and 34% had a dosage increase. Absolute risk reduction with CDE intervention was 30%.
“CDEs can be incorporated into the workflow of primary care; however, our funding for dissemination and sustainability is problematic,” Zgibor said during the presentation. Reimbursement for CDE services and buy-in from PCPs are challenges, she said, but this study demonstrates that using CDEs to implement treatment protocols to intensify treatment is feasible.
“This approach was well accepted by our physicians and their staff,” Zgibor said. “There were significant improvements in HbA1c, and they were sustained.” – by Jill Rollet
Reference:
Zgibor JC, et al. Abstract 208-OR. Presented at: American Diabetes Association’s 75th Scientific Sessions; June 5-9, 2015; Boston.
Disclosure: Zgibor reports no relevant financial disclosures.
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Linda M. Siminerio, RN, PhD, CDE
The work Zgibor is doing is fantastic. Mayer Davidson, MD, with Hispanic populations from California demonstrated [the value of] this work repeatedly. I saw that Zgibor acknowledged him in her presentation. [Certified diabetes educators] have to take the burden off primary care. Educators are well-trained — it’s ridiculous that we aren’t using systematic approaches like that.
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