Improving glycemic control in adults with diabetes mellitus: shared responsibility in primary care practices

South Med J. 2002 Jul;95(7):684-90.


Background: Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications

Methods: Primary care physicians referred patients with unsatisfactory glycemic control, frequent hypoglycemia, or inadequate self-management to an endocrinologist-directed team of nurse and dietitian educators for a 3-month program of intensive diabetes care. Patients had at least weekly contact with a diabetes educator and received changes in insulin and/or other medication, coupled with extensive individualized instruction. The main outcome measurement was change in glycosylated hemoglobin (HbA1c) level at 3 months.

Results: The first 350 patients who completed the program had overall mean decrease in HbA1c level of 1.7% (95% CI 1.4%-1.9%).

Conclusions: Barriers to improving glycemic control may be overcome by establishment of a system of collaboration between primary care providers and endocrinologist-directed diabetes educators.

MeSH terms

  • Adult
  • Diabetes Complications*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / nursing
  • Diabetes Mellitus / therapy*
  • Diet, Diabetic
  • Endocrinology*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hyperglycemia / prevention & control*
  • Hypoglycemia / prevention & control*
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Care Team* / standards
  • Patient Compliance
  • Patient Education as Topic
  • Physicians, Family*
  • Program Evaluation
  • Referral and Consultation
  • Regression Analysis
  • Self Care


  • Glycated Hemoglobin A