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A multifaceted intervention in support of diabetes treatment guidelines: a cont trial
Irl B Hirsch1, Harold I Goldberg, Allan Ellsworth
1Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356176, Seattle, WA 98195, USA. ihirsch@u.washington.edu
Objective:
in an academic family practice clinic, we performed a controlled trial of a multifaceted intervention versus usual care for managing diabetes. Providers received didactic training and computerized compliance feedback to support staged diabetes management, an evidenced-based approach to diabetes care.
Research Design And Methods:
one firm of the clinic practice received the intervention, the other served as the control group during a 14-month baseline period and a 14-month study period. HbA1(c) was the principal outcome measure.
Results:
there was a significant 0.71% difference in change in HbA1(c) values between the intervention and control firms (P=0.02). The subgroup with the greatest improvement in HbA1(c) was those subjects who started the intervention with a HbA1(c) above 8%. The overall improvement in glycemic control could not be explained by differences in visit frequency or the aggressiveness of drug therapy. There were no changes in healthcare utilization or costs between the two firms.
Conclusion:
in an academic family practice clinic, a multifaceted intervention in support of diabetes treatment guidelines modestly improved glycemic control without incurring additional costs. The improvement was mostly due to mitigation of the natural deterioration in control usually seen. Further efforts are required to involve all patients in co-managing their diabetes.