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Real-world comparison of HbA1c reduction at 6-, 12- and 24-months by primary care provider type
Patricia A Marin1, James F Bena2, Nancy M Albert3
1Department of Internal Medicine, Richard E. Jacobs Health Center, 33100 Cleveland Clinic Blvd., Avon, OH 44011, United States.
Insights
This study compared hemoglobin A1c (HbA1c) levels in diabetic patients managed by internal medicine physicians (IMP) or advanced practice nurses (APN). Both groups achieved similar HbA1c reductions over time, indicating comparable diabetes care effectiveness.
Area of Science:
- Internal Medicine
- Diabetes Management
- Advanced Practice Nursing
Background:
- Diabetes mellitus is a chronic condition requiring ongoing management.
- Effective diabetes care models are crucial for improving patient outcomes.
- Comparing different provider models can optimize patient care strategies.
Purpose of the Study:
- To compare hemoglobin A1c (HbA1c) changes over time in diabetic patients.
- To assess differences in HbA1c control between patients managed by internal medicine physicians (IMP) using a chronic care model and those managed by advanced practice nurses (APN).
Main Methods:
- Retrospective, 2-group comparative study using administrative databases.
- Subjects were matched 2:1 based on age, gender, and race.
- Longitudinal HbA1c levels were analyzed using linear mixed-effects models.
Main Results:
- A total of 269 patients (176 IMP-ancillary, 93 APN-IMP) were analyzed after matching.
- Baseline HbA1c was higher in the APN-IMP group (p<0.001).
- No significant between-group differences in HbA1c were observed at 6 and 12 months; a trend towards greater reduction was seen in the APN-IMP group at 24 months (p=0.097).
Conclusions:
- Both advanced practice nurse (APN) and internal medicine physician (IMP) management resulted in equivalent reductions in HbA1c compared to baseline.
- This suggests that APNs can provide diabetes care comparable to IMPs in terms of glycemic control.
Aims:
To assess differences in hemoglobin A1c (HbA1c) over time in diabetics treated by internal medicine physicians using the chronic care model (IMP-ancillary) or an advanced practice nurse (APN-IMP).
Methods:
Retrospective, 2-group comparative design using administrative databases and matching of IMP-ancillary and APN-IMP subjects 2:1 based on patient age (±3years), gender and race. Subjects were diabetics treated ≥2 times during 2007-2010, had ≥1 follow-up visit 6-months from baseline and ≥2 HbA1c levels. HbA1c levels were assessed longitudinally using linear mixed effect models. Pearson chi-square and two-sample t-tests compared groups on patient characteristics.
Results:
A total of 774 patients were identified. After matching 93 APN-IMP patients with 176 IMP-ancillary patients (N=269), there were no differences between groups in demographics; however, baseline mean (SD) HbA1c was higher in APN-IMP group, p<0.001. Compared to baseline, at follow-up there were no between-group differences in HbA1c levels at 6 and 12 months; at 24month follow-up, APN-IMP tended to have a large decrease in HbA1c compared to the IMP-ancillary group; mean difference (95% CI), -0.26 (-0.56, 0.05) p=0.097.
Conclusion:
Compared to baseline HbA1c, patients treated by APN-IMP and IMP-ancillary provider groups had equivalent reductions in HbA1c.
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