Group Visits Improve Outcomes in Type 2 Diabetes

Jan 3, 2011
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Participating in diabetic group visits (DGVs) helped patients with Type 2 diabetes to control their condition….

Lead investigator Mehvish Jawaid, MD, McLaren Regional Medical Center, Flint, Michigan, explained that a DGV is a shared medical appointment that involves multiple patients being seen in one visit to help deal with the control of a shared, chronic condition. These groups are most commonly used for health issues like diabetes and asthma, and are led by a multidisciplinary team of experts including faculty, residents, medical assistants, and nurses.

In this study, patients were divided into 2 groups. Group 1 consisted of 33 patients with diabetes who had not participated in DGVs, while Group 2 consisted of 18 patients with diabetes who had participated in DGVs because of referrals from primary-care physicians based on their poor control of diabetic measures. Changes in HbA1c levels, LDL levels, GFR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured in both groups over a 12-month period (calendar year 2009). Each group was divided into quartiles based on body mass indices (BMI) of 28 to 30, 31 to 35, 36 to 40 and >40.

In Group 1, the greatest improvement in Hb A1c appeared in the BMI subgroup 28 to 30 (23.40%) with only 3.07% improvement in the >40 BMI subgroup. In Group 2, however, Hb A1c improved steadily in the higher ranges of of 7-9%, which shows an improvement in diabetes control, Dr. Jawaid stated. LDL levels in Group 2 also improved steadily into the higher BMI ranges. This led to a decrease in the cardiovascular risk of those patients. GFR levels progressively declined for Group 1 across BMI subgroups, reaching -8.06% in the BMI >40 subgroup, while there was no significant change in GFR levels across BMI subgroups in Group 2 (P =.68). Finally, SBP and DBP did not significantly change at all for Group 1 or Group 2 across the BMI subgroups.

These results, the researchers noted, may have been influenced by 2 patient characteristics: (1) the most difficult-to-control patients with diabetes (such as those with higher BMIs) were selected for the DGVs through referrals from their physicians (presumably they would have more significant psychosocial challenges); and (2) there is a significant time commitment involved in regular DGV participation, which indicates that the patients with diabetes who participated in these groups would be automatically selected to be patients most committed to lifestyle change.

The investigators plan to extend their research study, focusing on understanding barriers to attending DGVs, formally measuring patient satisfaction and adding a nutritionist to the research team.

Presentation title: Diabetic Group Visits. Abstract RS016 the American Academy of Family Physicians (AAFP) 2010 Scientific Assembly.