A Multidisciplinary Diabetes Clinic Improves Clinical and Behavioral Outcomes in a Primary Care Setting

Abstract

The percentage of adults achieving hemoglobin A1c goals less than 7% remains a challenge. The study objective was to evaluate effects of a multidisciplinary approach on behavioral outcomes and mean change in A1c in immediate start (intervention) versus 6-month delay (control) groups at 6 months. The study assessed 111 patients recruited from a safety-net primary care clinic with a pharmacist-led multidisciplinary team and found that the intervention improved mean A1c outcomes for patients with type 2 diabetes. A1c values were measured every 3 months, and a self-efficacy scale to measure behaviors was evaluated at baseline and 6 months. After 6 months from baseline, the intervention group showed an A1c decrease of 2.4 compared with the control group's 1.1 decrease. Mean increase in selfefficacy score in the intervention group at baseline versus after 6 months showed a statistically significant change (P = .01) compared with the control group (P = .26). Results revealed a post hoc association between A1c and PHQ-9 such that patients with higher baseline PHQ-9 scores experienced greater mean decrease in A1c. In the immediate start arm, mean A1c values decreased from 10.6 at baseline to 7.7 at month 12. For the delayed intervention group, mean A1c values decreased from 10.2 at baseline to 9.0 after 6 months.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023

“…Various health care professionals working with people with diabetes may contribute to psychosocial care in different ways based on training, experience, need, and availability (313,326,327). Ideally, qualified mental health professionals with specialized training and experience in diabetes should be integrated with or provide collaborative care as part of diabetes care teams (328)(329)(330)(331), or referrals for in-depth assessment and treatment for psychosocial concerns should be made to such mental health professionals when indicated (314,332,333). A systematic review and meta-analysis showed that psychosocial interventions modestly but significantly improved A1C (standardized mean difference -0.29%) and mental health outcomes (334).…”

Mapping the evidence on clinical activities and outcome measures of pharmacist‐involved collaborative care models in managing diabetes: A scoping review

“…A total of 1468 articles were identified (n = 1456 from databases; n = 12 from manual search of references) of which 331 were duplicates and 2 articles were not accessible by the authors, leaving 1125 articles screened for eligibility (Figure 1). Thirty articles were reviewed after 1095 articles were excluded 11–40 …”

“…Other outcomes were body mass index, emergency department visits, hospitalizations, adverse events from drug use, and direct medical costs. Among the 30 studies, 10 (33.3%) of them evaluated PROs, with medication adherence, self‐efficacy and self‐care being most commonly evaluated (n = 5, 50.0%), followed by diabetes‐ and medication‐related knowledge (n = 4, 40.0%) 11–13,16,20,26,29,34,38,39 . Self‐efficacy refers to one's confidence and ability to self‐manage diabetes, including diet, physical activities, and treatment 42 .…”

“…Medication adherence, self‐care and self‐efficacy, diabetes and medication knowledge, treatment satisfaction, quality of life, and diabetes distress were evaluated in 8 of the 23 studies 13,16,20,26,29,34,38,39 . The results varied with two studies reporting no significant improvement in medication adherence and one study reporting no significantly improvement in self‐care 13,20,38 …”

“…A total of 24 studies incorporated health‐ and medication‐related education as part of the pharmacist intervention. Among these 24 studies, 20 studies evaluated changes in HbA1c and 19 of them reported positive finding 11,14–20,22–28,30–34,36,38–40 . Nine studies that evaluated blood pressure changes reported significant improvements, and seven studies that evaluated LDL‐c reported significant improvements.…”