Improving care of diabetic patients through a collaborative care model

The primary aim of this study was to evaluate the effectiveness of a hospital-based diabetes disease management program. Effectiveness was measured in terms of glycemic control and adherence to American Diabetes Association (ADA) standards of care. Patients participating in the Diabetes LifeCare program received diabetes self-management education, medical management by a primary care provider (PCP) supported by an evaluation and recommendations by a Diabetes LifeCare Advanced Practice Registered Nurse (APRN), nutritional counseling and quarterly follow-up appointments through one year. There was a statistically significant decrease in HbA1c from 9.3 to 7.2 to 6.8. During a six-month follow-up period, adherence to ADA standards for annual eye examinations increased from 64% to 82% and from 66% to 85% for foot examinations as part of a physician visit. Significant improvement in glycemic control and adherence to standards of care can be achieved through a comprehensive program of patient education and management that includes collaborative efforts with the patient's primary care provider.