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Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial

David Edelman1, Sonja K Fredrickson, Stephanie D Melnyk

  • 1Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA. dedelman@duke.edu <dedelman@duke.edu>

Annals of Internal Medicine
|June 2, 2010
PubMed

Insights

Group medical clinics effectively lower blood pressure in patients with diabetes and hypertension. However, they did not significantly improve hemoglobin A1c levels compared to usual care.

Area of Science:

  • Internal Medicine
  • Clinical Research
  • Health Services Research

Background:

  • Group medical clinics (GMCs) are utilized for managing diabetes and hypertension.
  • Limited data exist on the effectiveness of GMCs for these conditions.

Purpose of the Study:

  • To evaluate the efficacy of GMCs in managing comorbid diabetes and hypertension.
  • To compare GMCs against usual care for these chronic conditions.

Main Methods:

  • A randomized controlled trial involving 239 patients with poorly controlled diabetes and hypertension.
  • Patients were assigned to either GMCs or usual care at two Veterans Affairs Medical Centers.
  • Intervention involved structured group sessions with a multidisciplinary team, with medication adjustments to manage HbA1c and blood pressure.

Main Results:

  • Mean systolic blood pressure improved significantly more in the GMC group (13.7 mm Hg) than in the usual care group (6.4 mm Hg) (P=0.011).
  • Mean hemoglobin A1c (HbA1c) levels improved in both groups (0.8% in GMC, 0.5% in usual care), with no statistically significant difference between them (P=0.159).

Conclusions:

  • Group medical clinics demonstrate effectiveness in improving blood pressure control for diabetic patients.
  • GMCs did not show a significant benefit over usual care in improving HbA1c levels.
  • Concomitant improvements in the usual care group may have influenced the study's outcome measurements.
Abstract

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