Objective: As diabetes technologies increase in prevalence and complexity, flexible models of care are needed to provide ongoing support. The objective of this study is to determine whether a streamlined Diabetes Device Clinic (DDC) model is associated with improvement in glycemic control and education utilization among insulin pump users.
Research Design and Methods: The DDC was available for patients in need of focused device-related education; all patients had previously received comprehensive education and insulin pump training. The DDC consists of an abbreviated visit with a certified diabetes educator (CDE, 40 minutes) followed by a hand-off and visit with the endocrinologist (20 minutes). Participants were compared to insulin pump users who received traditional care. Pre- and post-HbA1c values were obtained within 6 months prior to and 6 months after the DDC visit. The two most recent HbA1c values at least 3 months apart were obtained for non-device clinic patients.
Results: A total of 437 patients were identified, 79 of whom attended the DDC. Of the non-attendees (n=358), 48.7% were referred to the CDE and 39% completed an education visit. Among patients with a baseline HbA1c >8.0%, those who attended the DDC witnessed a significant reduction in HbA1c (-0.52% +/- 0.71, p=0.002) whereas non-attendees saw no such improvement (-0.14% +/- 1.29, p=0.29). For patients with a baseline HbA1c <8.0%, there was a slight increase in HbA1c in DDC attendees and no change in non-attendees (0.20% +/- 0.66, p=0.028, vs. 0.04% +/- 0.54, p=0.24 respectively). Multivariable analysis confirmed a significant interaction between baseline HbA1c and DDC. Results were similar in patients receiving traditional education.
Conclusions: These data illustrate that the streamlined DDC model of care may improve glycemic control and education utilization among established insulin pump patients. Additional study is needed to address ongoing education needs.
C.K. Park: None. J.G. Zappe: None. E. Snyder: None. K.M. Dungan: Advisory Panel; Self; Eli Lilly and Company, Elsevier, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company, GlaxoSmithKline plc., Novo Nordisk Inc., Sanofi-Aventis, Viacyte. Other Relationship; Self; DKBmed, UpToDate.