It Takes a Team to Control Diabetes

By getting all the parties involved in treatment, significantly more diabetes patients were able to achieve goal for glycosylated hemoglobin A1c, blood pressure, and LDL cholesterol, Swarna Varma, MD, of the University of Pittsburgh told attendees at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. 

Varma and her colleagues used the “Team of 4 approach” with 396 diabetes patients. They reported the following five-year results:

• 42% of patients had an HbA1c of less than 7% compared with just 30% at that goal at baseline
• 58% had gotten LDL cholesterol below 100 mg/dl; at baseline, just 35% were that low
• 62% of patients had blood pressure at less than 130/80 mmHg, compared with 45% of patients at baseline

Overall, 18% of patients hit all three goals, compared with just 5% at baseline.

“All of these differences did achieve statistical significance,” Varma told MedPage Today.

“We think this ‘Team of 4 approach’ has shown positive benefit on patient outcomes and the use of evidence-based medicine,” she said.

In addition to gains in achieving goals, Varma also observed that patients were more likely to receive medications according to American Diabetes Association guidelines, and they also received laboratory monitoring according to guidelines.

She noted that at baseline about 65% of patients were prescribed either angiotensin-converting enzyme inhibitor medication or angiotensin receptor blockers, but at the five-year point acting through the “Team of 4 approach” about 80% of patients were receiving these prescriptions.

Varma and her colleagues performed the retrospective medical record database analysis, including diabetes patients over age 18 treated under the “Team of 4 approach” between 2004 and 2009.

She noted that according to the National Health and Nutrition Examination Survey, about half of diabetes patients achieve individual A (HbA1c), B (blood pressure), and C (cholesterol) goals and just 5% to 12% achieve all three.

“Our study shows that a team approach makes it possible to achieve better than average with our patients,” Varma said.

Practice Pearls:

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Explain that a retrospective chart review showed that diabetic patients treated with the “Team of 4” approach were more likely to receive care according to guidelines and to achieve HbA1c, blood pressure, and LDL goals.
• Note that comparisons were made with the same patients at baseline and that the “Team of 4” included physicians, support staff, patients, and committed family members.

World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease: Varma S, et al “Achieving ABC’s of diabetes care with ‘a team of 4 approach'” WCIR 2010; Abstract 108.