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Improving Glycemic Control Through Population-Based Strategies: A Case-Control Study Within a Large Health System
Taynara Formagini1,2, Minyong Kim3, Xing Wei4
1Department of Research & Evaluation, Division of Health Services Research and Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, USA. taynara.x.formagini@kp.org.
Journal of General Internal Medicine
|May 1, 2026
Summary
Diabetes Self-Management Education and Support (DSMES) improved A1c control in type 2 diabetes patients. Population care management was less effective than primary care physician-led care, with optimal encounter frequency showing diminishing returns.
Area of Science:
- Endocrinology
- Public Health
- Health Services Research
Background:
- Nearly half of US adults with type 2 diabetes (T2D) do not achieve glycemic control (A1c < 7%).
- This increases the risk of diabetes-related complications.
- System-level strategies are recommended, but real-world impact on A1c control is unclear.
Purpose of the Study:
- To examine the association between T2D management program components and A1c target attainment.
- To investigate the relationship between encounter frequency and A1c control.
Main Methods:
- Retrospective nested case-control study (2017-2022) of T2D patients with baseline A1c ≥ 7%.
- Cases achieved two consecutive A1c < 7% within 2 years.
- Predominant encounter types (PCP, PCM, DSMES) and encounter frequency were analyzed using conditional logistic regression.
Main Results:
- Patients with Diabetes Self-Management Education and Support (DSMES) had higher odds of achieving A1c target (OR 1.39).
- Population Care Management (PCM) encounters were associated with lower odds of A1c target attainment (OR 0.78) compared to Primary Care Physician (PCP) care.
- A1c control improved with encounter frequency up to 9-14 visits, then diminished.
Conclusions:
- DSMES is associated with improved glycemic control in T2D.
- Enhancing DSMES reach and effectiveness may help patients achieve sustained glycemic control.
- Further research into optimal care delivery models for T2D is warranted.
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