Simulated physician learning intervention to improve safety and quality of diabetes care: a randomized trial

Diabetes Care. 2009 Apr;32(4):585-90. doi: 10.2337/dc08-0944. Epub 2009 Jan 26.


Objective: To assess two physician learning interventions designed to improve safety and quality of diabetes care delivered by primary care physicians (PCPs).

Research design and methods: This group randomized clinical trial included 57 consenting PCPs and their 2,020 eligible adult patients with diabetes. Physicians were randomized to no intervention (group A), a simulated case-based physician learning intervention (group B), or the same simulated case-based learning intervention with physician opinion leader feedback (group C). Dependent variables included A1C values, LDL cholesterol values, pharmacotherapy intensification rates in patients not at clinical goals, and risky prescribing events.

Results: Groups B and C had substantial reductions in risky prescribing of metformin in patients with renal impairment (P = 0.03). Compared with groups A and C, physicians in group B achieved slightly better glycemic control (P = 0.04), but physician intensification of oral glucose-lowering medications was not affected by interventions (P = 0.41). Lipid management improved over time (P < 0.001) but did not differ across study groups (P = 0.67).

Conclusions: A simulated, case-based learning intervention for physicians significantly reduced risky prescribing events and marginally improved glycemic control in actual patients. The addition of opinion leader feedback did not improve the learning intervention. Refinement and further development of this approach is warranted.

Trial registration: NCT00262704.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cholesterol, LDL / blood
  • Computer Simulation
  • Coronary Disease / therapy
  • Diabetes Mellitus / therapy*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / therapy
  • Education, Medical* / standards
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Learning*
  • Male
  • Metformin / therapeutic use
  • Middle Aged
  • Physicians, Family / education*
  • Quality Assurance, Health Care
  • Risk Assessment
  • Safety


  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Metformin

Associated data