Impact of a Diabetes Disease Management Clinic on the Total Glycosylated Hemoglobin of Patients With Type 2 Diabetes Mellitus

Abstract

OBJECTIVE: To assess the impact of a diabetes disease management clinic (DDMC) on the total glycosylated hemoglobin of patients with type 2 diabetes mellitus. DESIGN: Retrospective chart review. SETTING: A Veterans Affairs Health Care System where patient care was provided either by traditional medical management or by a pharmacist or nurse practitioner in a diabetes disease management clinic. PATIENTS: 81 veterans with type 2 diabetes mellitus managed with oral antidiabetic agents alone. These patients were divided into two groups: 1) those who were initiated on self-monitoring of blood glucose (SMBG) by their primary care provider (control group); and 2) those who began receiving care in the DDMC when they initiated 5MBG (treatment group). MAIN OUTCOME MEASURES: Change in total glycosylated hemoglobin value from baseline values. RESULTS: The median baseline total glycosylated hemoglobin values were similar between the two groups (11.5% vS.11.4%, P=0.550). Patients enrolled in the DDMC achieved a significantly greater reduction in glycosylated hemoglobin compared to those patients not enrolled in the clinic (-1.6% vs. -0.4%, P=0.047). Patients who were not enrolled in DDMC also failed to achieve a significant reduction in glycosylated hemoglobin from baseline (P=0.231), whereas the follow-up glycosylated hemoglobin values in patients enrolled in the DDMC were significantly lower than baseline (p less than 0.001). CONCLUSION: Participation in the DDMC appeared to be associated with improved glycemic control. Furthermore, patients who received 5MBG alone did not benefit; only patients who were enrolled in clinic in addition to the initiation of 5MBG achieved a reduction in total glycosylated hemoglobin.