Aim : Diabetes mellitus (DM) care delivery is often fragmented because of logistical constraints. We examined if cohesive short-term multidisciplinary care improves diabetes-related outcomes.

Methods: This was a prospective, non-randomized pilot study. Adults with type 2 DM, A1C ≥8% and ≥1 comorbidity attended either 1) a multidisciplinary clinic (endocrinologist, pharmacist, diabetes educator/nutritionist and at least one specialty e.g. cardiology, nephrology, ophthalmology on the same/next day), or 2) conventional visits spread apart. A1C (primary outcome) and other variables were collected at baseline, 6 months (exit from active part of study), and 12 months (6 months from exit).

Results: There were 20 patients per arm (55.3% female, mean ± SD age 53.8 ± 11.3 y, BMI 40.1 ± 10.0 kg/m2, A1C 10.1 ± 2.1%). Of the patients that have reached the 6-mo mark so far, intervention group showed a significant decrease in A1C (n=14, from 10 ± 1.4 to 8.7 ± 1.8, delta -1.4 ± 1.4; p=0.003), while there was no significant change in the control group (n=6, from 9.6 ± 2.5 to 7.6 ± 1.3, delta -2.0 ± 2.9; p=0.15) (Figure 1).

Conclusion: The ADA endorses an evidence-based model of a collaborative, multidisciplinary team to provide care for people with diabetes. However, achieving this can be difficult in a large, progressively subspecialized healthcare system. Initial data from our study shows defragmenting patient care can improve A1C over a conventional model.

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Disclosure

A.Iqbal: None. M.Parker: None. A.Smith-coleman: None. R.J.Marquardt: None. M.A.Maier: Speaker's Bureau; Smith+Nephew. M.Lansang: Research Support; Dexcom, Inc., Abbott, Alertgy Inc. R.S.Zimmerman: Speaker's Bureau; Xeris Pharmaceuticals, Inc. D.Isaacs: Speaker's Bureau; Dexcom, Inc., Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk. J.F.Bena: None. J.Morren: None. R.Singh: Consultant; Genentech, Inc., Iveric Bio, Alcon Research, LLC, Regeneron, Novartis, REGENXBIO Inc. G.Thomas: None. M.L.Griebeler: None.

Funding

Cleveland Clinic Healthcare Delivery & Implementation Science Center

© 2023 by the American Diabetes Association
2023
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