Changing the process of diabetes care improves metabolic outcomes and reduces hospitalizations

Qual Manag Health Care. 1998 Sep;6(4):53-62. doi: 10.1097/00019514-199806040-00006.

Abstract

We designed and evaluated an ambulatory care intervention aimed at improving glycemic control and reducing hospitalizations in patients with insulin-dependent diabetes mellitus (IDDM). One hundred seventy-one youth with IDDM, ages 10-15, were assigned either to a Care Ambassador intervention (N = 89) or to standard care (N = 82). The intervention consisted of scheduling, confirming, and documenting medical follow-up for 24 months. During the study, the intervention group had more diabetes visits, 7.1 +/- 1.50 (mean +/- SD) Vs. 5.2 +/- 2.57 in the standard care group (P = 0.0001). In the at-risk subjects (baseline HbA1c 8.1%, N = 162), 50% of intervention subjects compared with 29% of standard care achieved HbA1c 8.6% while 17% of intervention subjects compared with 32% of standard care had values > 9.6% (P = 0.039). During follow-up, severe hypoglycemia and hospitalization/ER use occurred at half the rate in the intervention group compared with standard care. This specific, low-cost intervention aimed at increasing ambulatory medical visits in at-risk patients with diabetes improves metabolic outcomes and significantly reduces hospital/ER use.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism
  • Boston
  • Child
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 1 / therapy*
  • Disease Management*
  • Emergency Service, Hospital / statistics & numerical data
  • Glycated Hemoglobin A / metabolism
  • Hospitalization / statistics & numerical data*
  • Humans
  • Outcome and Process Assessment, Health Care / methods*
  • Treatment Outcome

Substances

  • Blood Glucose
  • Glycated Hemoglobin A