Many studies recommend that efficient diabetes care should be provided by a multidisciplinary team, but the optimal team composition and the independent contribution of each type of health professional on the studied outcomes are not well known. Additionally, real world evidence is needed to better understand the effectiveness of group approach strategies.
Objectives: to examine the effect of multidisciplinary intervention and group therapy on diabetes control.
Methods: A retrospective cohort study was performed among poorly controlled type 2 diabetes patients (HbA1c≥9%) insured by Maccabi Health Services, between 2012-2015. At the end of two-year follow-up (2013-2014), patients were divided into 2 groups, well controlled (HbA1c≤8%) and poorly controlled diabetes (HbA1c≥9%). Visits to each health professional (family physician/nurse/diabetic nurse/dietitian/etc.) and participation in diabetic group seminars were compared between these groups. Multivariable logistic regression was performed to assess the optimal multidisciplinary team composition associated with glycemic control.
Results: Of 8,811 eligible patients with HbA1c≥9% at baseline, 2,753 (31.2%) reached well-controlled diabetes and 3,929 (44.6%) remained poorly controlled. In multivariate analysis, primary care physician, dietitian and exercise specialist visits were significantly associated with glycemic control (p<0.05).
Visits to a dietitian and exercise specialist improved glycemic control by 18% and 16% respectively, and care by family physician improved it by 1%.
In a multivariable model accounting for the number of visits to each provider and glycemic control, each additional group session improved the likelihood of achieving glycemic balance by 13%.
Conclusion: These results suggest that the optimal treatment of poorly controlled diabetes is a multidisciplinary team consists of physician, dietitian and exercise specialist, combined with diabetes group education.
L. Gabay: None. I. Menashe: None. I. Yehoshua: None.
Maccabi Healthcare Services