Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review

Abstract

Type 2 diabetes mellitus (T2DM) is a complex chronic disease affecting over 400 million people worldwide. Managing T2DM and its associated complications in individual patient consultations poses substantial challenges to physicians due to limited time and resources and lack of access to multidisciplinary teams. Shared medical appointments (SMAs) are consecutive medical consultations provided by a physician in a group setting, where integrated medical care and patient education are delivered in a single session. SMAs allow physicians to deliver the same level of care to multiple patients at the same time, thereby maximizing available resources. However, the effectiveness and practicality of SMAs in the management of T2DM remains unknown. This narrative review summarizes current and emerging evidence regarding the effectiveness of SMAs in improving clinical outcomes in patients with T2DM, as well as whether SMAs are associated with reduced costs and improved diabetes-related behavioral and lifestyle changes. An extensive literature search was conducted on major electronic databases including PubMed and Google Scholar using keywords, including SMAs, group visits, and T2DM to identify all studies of SMAs in patients with T2DM. Studies in type 1 diabetes or mixed or unspecified populations were excluded, as well as studies where SMAs did not involve a physician since these do not meet the classical definition of a SMA. Nineteen studies were identified and are included in this review. Overall, current evidence suggests that SMAs delivered regularly over time may be effective in improving glycemic outcomes, diabetes knowledge, and some diabetes-related behaviors. However, the main limitation of existing studies was the paucity of comparisons with standard care which limits the ability to draw conclusions regarding whether SMAs are superior to standard care in T2DM management. Moreover, the small number of studies and substantial heterogeneity in study designs, populations, and interventions creates difficulties in establishing the practicality and efficiency of SMAs in the clinical care setting. We conclude that there remains a need for larger studies to identify populations who may or may not benefit from the SMA model of care and to clarify the potential benefits and barriers to implementing SMAs into routine diabetes care.

Shared Medical Appointments and Mindfulness for Type 2 Diabetes—A Mixed-Methods Feasibility Study

“…Qualitative evaluation demonstrated that pSMA participants found the program to be positive overall, with multiple benefits such as increased acceptance of their diagnosis, feeling empowered, making changes with their lifestyle, and enjoying the opportunity to meet people who were in the “same boat” as them. Our findings are consistent with previous studies on SMAs for people with T2DM with patient satisfaction generally being high, diet and physical activity habits improving, and patients being able to achieve or almost achieve their self-prescribed goals ( 10 ).…”

“…Similarly, mean glucose from CGMS decreased and time in range increased in the SMA group whereas the opposite was observed in the control group. This is consistent with findings from other studies reporting lower HbA1c ( 10 ), however, remains to be confirmed in a fully-powered RCT. However, there was little change in anthropometric measurements or blood pressure.…”

“…The evidence on SMAs for T2DM is inconsistent, mostly due to heterogeneity of the interventions and sample characteristics; however, there is some evidence for reduction of HbA1c, weight, blood pressure, lipids, and improved quality of life and patient satisfaction ( 10 ). SMAs are also cost-effective compared to one-on-one care ( 8 ).…”

Adipose depot-specific effects of ileal interposition surgery in UCD-T2D rats: unexpected implications for obesity and diabetes

“…The unquestioned role of obesity-induced insulin resistance in the pathogenesis of type-2 diabetes mellitus (T2DM), a metabolic disease estimated to affect more than 400 million people worldwide [1], is an important indication of the strong link between dysregulation of cellular energy metabolism and the development of T2DM.…”

The “A to Z” of Managing Type 2 Diabetes in Culturally Diverse Populations

“…Group classes have been long recognized as a strategy to empower patients through peer support ( 69 ). More recently, shared medical appointments or group medical visits have emerged as an effective strategy to provide clinical care to patients ( 70 ). However, more research is needed to identify best candidates for this type of clinical care model.…”