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Can Bundled Therapy Reduce Risk of Vascular Complications?

Under a new system of care, diabetes-related macro- and microvascular complications. are managed as well as glucose control… 

A study approved by Geisinger Institutional Review Board was conducted to evaluate diabetic patients who are under the care of the diabetes system (n=4095) compared to patients provided with the usual primary care (n=4095) for 3 years. The diabetes system of care includes 9 components of diabetes measures, restructure of the workflow, tools for electronic health records, and a financial incentive for improvement of care.

The group of patients under the care of diabetes system (n=4095) were found to have a significant reduction in the risks of microvascular and macrovascular events based on the calculated hazard ratios. The hazard ratios for the following events: MI 0.77 (95% CI 0.65-0.9), stroke 0.79 (95% CI 0.65-0.97) and retinopathy 0.81 (95% CI 0.68-0.97). However, there was no difference shown in the study for major amputations, hazard ratio 1.32 (95% CI 0.45-3.85).

Implementing the best care for patients with diabetes can be very challenging considering that many factors are involved to successfully accomplish it. Management of diabetes does not solely rely on glucose control but also relies on prevention and management of other things such as cardiovascular diseases, if patients are at high risk for it or if already diagnosed, respectively. Financial cost of the care can be quite challenging as well.

Further research and studies are needed to determine whether bundled care for diabetic patients is more effective and beneficial compared to patients with standard care, in terms of overall quality of life (morbidity, mortality) and the total cost of the care delivered. 

Practice Pearls:
  • There is a significantly lowered risk for MI, stroke and retinopathy in patients under the system of care for diabetes in only 3 years.
  • Glycemic control reduces the risk of microvascular events but no significant reduction in the risk of macrovascular events.
  • It is crucial to find a new strategy of care to manage people with diabetes when it comes to both glucose control and improvement of quality of life. 

Bloom FJ, Yan X, Walter SF, et al. Primary Care Diabetes Management: 3- Year Outcomes for Microvascular and Macrovascular Events. Am J Manag Care. 2014 June 26