Diabetes Care Network: A Novel Model to Disseminate Team-Based Diabetes Specialty Care in a Rural Population.
Margaret F Zupa, Janice Beattie, Monique Boudreaux-Kelly and 5 others
PMID 36125114WHAT IT FOUND
A remote team-based diabetes care model was associated with lower A1C in rural Veterans.
There was no concurrent control group, so it does not prove the model caused the change.
Key findings
01In the Butler cohort, mean A1C decreased by 2.06% over the 12-month intervention; in the Erie cohort, it decreased by 3.03%.
02In the 12 months before enrollment, mean A1C had increased by 1.21% in Butler and by 1.08% in Erie.
03Other outcomes were mixed: LDL and systolic blood pressure improved significantly only in Butler, while weight change was not significant in either cohort.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no concurrent control group, so the A1C and other outcome changes cannot be attributed to the Diabetes Care Network alone. The intervention combined several components, including diabetes self-management education, medication optimization, home glucose monitoring, nutrition consultation when applicable, local liaison follow-up, and weekly team huddles, and the study did not separate their effects. The historical comparison was only for A1C before enrollment, and missing A1C values were common for the earlier historical timepoints. The study was done in a large integrated Veterans Affairs network with rural, mostly white, mostly male Veterans, so results may not transfer to other health systems or populations. The study could not measure diabetes self-management education hours or the independent effect of nutrition consultation because those services were not separately billed or analyzed.
Declared interests
The authors declared no conflict of interest. The paper is listed as supported by N.I.H. extramural research.
The easy way to misread this
Do not conclude that the remote diabetes team caused the A1C reductions. This was an uncontrolled pre-post quality improvement study, and patients received several concurrent components, including diabetes self-management education, medication optimization, home glucose monitoring, nutrition consultation when applicable, local liaison follow-up, and weekly team huddles.