Diabetes Dateline
Spring/Summer 2009

Improving Delivery of Diabetes Care

Primary health care practices that proactively deliver diabetes care see greater improvements in patients’ cholesterol, blood pressure, and blood glucose levels and adherence to routine screenings such as foot checks, according to results from a trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

“Problems with the organization and delivery of health care services contribute to the nation’s inability to reach current evidence-based goals for optimal chronic disease control,” wrote Kevin Peterson, M.D., M.P.H., an associate professor at the University of Minnesota, and co-authors, whose report appeared in the December 2008 issue of Diabetes Care.

The TRANSLATE trial, which involved 24 community primary practices and more than 8,000 patients, tested whether an intervention—specific changes to the process of delivering care—could improve the control of patients’ diabetes. The intervention included establishing an electronic diabetes registry for each practice, which produced visit reminders, patient-specific physician reminders, identification of patients with incomplete or overdue tests, alerts of patients with elevated clinical diabetes measures, and a monthly summary for practice staff.

People with type 2 diabetes cannot regulate blood glucose, also called blood sugar, normally, which contributes to a variety of health problems, including cardiovascular disease, blindness, kidney disease, and amputations. Most people with diabetes do not achieve levels of glucose, blood pressure, and cholesterol proven to reduce heart disease and other diabetes complications.

Improvements

Use of the intervention by the practices led to increases in the percentage of diabetes patients who met performance measures for foot and eye examinations, tests for kidney function, blood pressure monitoring, and tests for cholesterol and hemoglobin A1C (A1C)—a 3-month average of blood glucose levels.

After 1 year, patients in practices using the intervention showed significantly greater improvement in achieving the recommended levels for blood pressure, cholesterol, and A1C than patients in control practices. The new research shows that a multifaceted organizational intervention in community primary practices can significantly improve diabetes care and outcome.

The NIDDK supported this trial as part of an initiative to develop cost-effective and sustainable interventions that could be adapted in real-world settings to prevent and control diabetes and obesity.

NIH Publication No. 09–4562
August 2009

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