Improving Glycemic Control Through Population-Based Strategies: A Case-Control Study Within a Large Health System

Nearly half of US adults with type 2 diabetes fail to achieve glycemic control (A1c < 7%), increasing complication risks. The American Diabetes Association recommends system-level strategies to optimize care delivery, yet the real-world impact of population-based programs on A1c control remains unclear.

To examine the association between three components of a diabetes management program and attainment of target A1c in patients with type 2 diabetes, as well as the relationship between encounter frequency and target A1c.

This retrospective nested case-control study utilized data from Kaiser Permanente Southern California (2017-2022).

Patients with type 2 diabetes and baseline A1c ≥ 7%. Cases (two consecutive A1c < 7% within 2 years) were matched to controls based on baseline A1c and follow-up duration.

The primary exposure variable was predominant encounter type: (1) primary care physician (PCP), (2) population care management (PCM), and (3) Diabetes Self-Management Education and Support (DSMES). The secondary exposure variable was encounter frequency. Conditional logistic regression assessed the independent effects of predominant encounter type on A1c, adjusting for covariates.

The sample consisted of 317,284 patients (94,647 cases), with a median age of 59 years, and 49% Hispanic. Patients with DSMES as their predominant care had higher odds of achieving A1c target (OR 1.39, 95%CI 1.35, 1.42), while those with predominantly PCM encounters had lower odds of achieving A1c target (OR 0.78, 95%CI 0.77, 0.80), compared to PCP-led care. Findings were consistent across racial and ethnic minority groups. The odds of achieving A1c control increased with encounter frequency up to 9-14 visits but diminished beyond this threshold, particularly at 25+ encounters.

Further resources devoted to enhancing the reach and effectiveness of DSMES may help more patients living with diabetes achieve sustained glycemic control and prevent complications.