ADA: 'Boot Camp' Reins in Uncontrolled T2D

Lower healthcare costs and HbA1c for T2D patients

NEW ORLEANS -- Adults with uncontrolled type 2 diabetes who attended a "diabetes boot camp" where they were educated about their condition and then given remote monitoring tools to track it, reported significantly less healthcare utilization, as well as a small, but significant drop in their A1c levels, a small study presented here found.

After 6 months of intervention, urgent primary care visits dropped 92%, self-reported emergency room visits fell 89%, and missed days of work or usual activities were down 77% compared with baseline, reported Michelle F. Magee, MD, of MedStar Health in Washington D.C., and colleagues.

At 3 months, mean HbA1c dropped from 11.4% to 8.3% at 3 months (P<.001). Researchers even compared the intervention patients to a group of matched controls that received standard diabetes management from the primary care provider and found their HbA1c only dropped to 9.8% after 3 months.

"There are actually a fair number of studies showing that increased access to the healthcare system does help diabetes control," Victoria Hsiao, MD, of University of Rochester Medical Center in Rochester, N.Y., told MedPage Today. "It's important because most diabetes care is via primary care physician -- there aren't enough endocrinologists or diabetologists to see patients with diabetes." Hsiao was not involved with the research.

But Magee also pointed out at a late-breaking poster presentation at the American Diabetes Association annual meeting that primary care physicians also don't have the amount of time it takes to educate their patient about diabetes and get them comfortable with taking their medication.

"We got buy-in [from PCPs] when we conceived the concept -- to take their patients and wrap our arms around them for 12 weeks and give patients the education that we know they need," she told MedPage Today.

How did they do it? A program offered at five primary care practices enrolled 125 total patients, who were a mean age of 57 years (though this interim analysis only focuses on the first 81) for a 12-week intervention. Patients had two one-on-one visits with an endocrinologist-supervised certified diabetes educator.

They were then given an FDA-cleared remote monitoring system to track their blood glucose levels and transmit the results to a provider dashboard. The certified diabetes educator would contact the patients by phone, text or email for 8-10 "virtual visits" about medication or lifestyle adjustments until their glycemic targets were met.

At the end of 12 weeks, the patients were sent back to their primary care physician with a letter detailing their progress.

"It saves the primary care physician a lot of time, because they don't have time to be calling the patients and doing this, so they're really happy with it, and the patients are so satisfied because they get the care that they need in the short period of time, and they don't have to come back to the office," co-author Gretchen Youssef, MD, also of MedStar Health, told MedPage Today at a late-breaking poster presentation at the American Diabetes Association annual meeting.

The patients were also satisfied with the results, with 94% saying they were "highly satisfied" with the structure of the program (two in-person visits, followed by virtual follow-up) and 98% saying they were "highly satisfied" that the program helped them reach their diabetes control goals.

Blood sugar levels for the patients were kept in a logbook, which Hsiao said was a good idea because then the patients knew that someone was looking at them.

"I have a lot of patients get frustrated and they say 'Why should I bother -- no one looks at them,'" she said. "So, it's great to have someone say 'This is why we asked you do to this' because otherwise the finger sticks are literally a pain."

Magee hopes to expand the program, but acknowledges it will be a challenge to both sustain this program in the current practices, as well as scale up and expand it.

Action Points

• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Preliminary evidence demonstrates a significant impact on glycemic control and healthcare utilization as the result of a concise, focused education and medication management intervention in patients with uncontrolled diabetes mellitus (DM).
• Note that 94% of patients said they were "highly satisfied" with the program and 98% said they were "highly satisfied" that the program helped them reach their diabetes control goals.

Magee disclosed consultancy with the American Diabetes Association and Sanofi U.S.

Other co-authors reported relationships with Eli Lilly.

Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner

This activity is part of our Clinical Context curriculum in Diabetes

last updated 06.17.2016

Primary Source: American Diabetes Association

Source Reference: Magee MF, et al "Diabetes boot camp reduces A1c and health-care services utilization" ADA 2016; Abstract 142-LB.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.