Summary

The purpose of this study is to determine interventions associated with significant improvement in the management of adult type 2 diabetes.  A Clinical Practice Improvement study was conducted at four West Coast ambulatory clinics between March 1999 and December 2002.  Data were collected on 228 patients for 3,069 diabetes care visits, and multivariate analyses were performed.  Initial results found that after controlling for severity of illness, self-monitoring of blood glucose along with consistent provider discussion was strongly associated with good serum glucose control and with less hospitalization.  Also found were optimal glucose control medication treatments.

Primary Objectives

1. Improve clinical outcomes, service, and cost throughout the continuum of ambulatory care in adult type 2 diabetes patients.

2. Avoid or postpone the onset of serious adult type 2 diabetes complications.

3. Create research-based optimal treatment protocols for adult type 2 diabetes.

Methods

Detailed patient, treatment, and outcome data were collected on 228 adult type 2 diabetes patients 35-65 years old.  The patients had 3,069 diabetes care visits to 65 physicians. Patients were followed for 3 years.  Multivariate analyses determined areas of significant improvement in the management of adult type 2 diabetes patients.

Results

1. Self-monitoring of blood glucose along with consistent provider discussion throughout the 3-year study period was strongly associated with good serum glucose control.  Seventy percent of  48 patients who regularly performed self-monitoring and had consistent documentation of discussions about the results with their providers had almost all of their Hemoglobin Alc values < 8%.  In contrast, 82% of 96 patients who performed self-monitoring irregularly or did not have consistent documentation of discussions about the results with their providers, and 78% of 84 patients who did not perform self-monitoring, had almost all of their Hemoglobin Alc values > 8% (p<0.0001).
   

2. Self-monitoring of blood glucose was strongly associated with less hospitalizations.  Fifty-five percent of patients with evidence of monitoring during at least one visit were hospitalized at least once compared with 76% of patients with no evidence of self-monitoring were hospitalized at least once (p=0.0023).
   

3. Optimal glucose control treatment:  Patients receiving three or more injections of insulin per day (with or without oral hypoglycemics) had lower mean Hemoglobin Alc values than patients receiving any other form of treatment (average Hemoglobin Alc of 8.4% vs. 9.4% (p=0.026)).

Impact

The findings from the study of adult outpatients with type 2 diabetes in actual practice of care confirm findings from randomized trials of similar patients.  These indicate that intensive therapy is an effective way to reach the major goals of diabetes treatment:  lowering blood glucose to appropriate levels and avoiding and postponing the onset of serious complications.  Additional analyses of these data are underway.