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Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial

Aanand D Naik1, Nynikka Palmer, Nancy J Petersen

  • 1Michael E. De-Bakey VAMC (152), Houston Health Services Research and Development Center of Excellence, 2002 Holcombe, Houston, TX 77030, USA. anaik@bcm.edu

Archives of Internal Medicine
|March 16, 2011
PubMed

Insights

Empowering Patients in Care (EPIC) group clinics significantly improved diabetes mellitus (DM) glycemic control, as measured by HbA1c levels, for one year. Structured goal-setting in DM group clinics enhances self-management and maintains glycemic control.

Area of Science:

  • Endocrinology
  • Primary Care Medicine
  • Health Services Research

Background:

  • Diabetes mellitus (DM) group clinics effectively manage hypertension, but their impact on glycemic control remains uncertain.
  • Evaluating comparative effectiveness of two DM group clinic interventions for improving HbA1c in primary care.

Purpose of the Study:

  • To compare the effectiveness of two primary care-based DM group clinic interventions on HbA1c levels.
  • To assess the long-term impact of these interventions at a 1-year follow-up.

Main Methods:

  • A randomized comparative effectiveness study involving 87 participants from a DM registry.
  • Two 3-month interventions: Empowering Patients in Care (EPIC) - clinician-led, patient-centered with action plans, and a comparison group receiving standard education and primary care visits.
  • HbA1c levels were measured post-intervention and at 1-year follow-up.

Main Results:

  • The EPIC intervention group showed significantly greater HbA1c reduction immediately post-intervention (8.86% to 8.04%) compared to the control group (8.74% to 8.70%).
  • These improvements were sustained at the 1-year follow-up, with a mean difference favoring EPIC (0.59%).
  • A significant time-by-treatment interaction favored the EPIC intervention (P=.03), partially mediated by DM self-efficacy (P=.002).

Conclusions:

  • Primary care-based DM group clinics incorporating structured goal-setting for self-management significantly improve HbA1c levels.
  • These improvements are maintained for at least one year post-intervention.
  • The EPIC model demonstrates effectiveness in enhancing glycemic control through patient-centered, self-management strategies.
Abstract

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