title: Improving glycemic control in adults with diabetes mellitus: shared responsibility in primary care practices.
abstract: BACKGROUND
  Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications
  
  
  METHODS
  Primary care physicians referred patients with unsatisfactory glycemic control, frequent hypoglycemia, or inadequate self-management to an endocrinologist-directed team of nurse and dietitian educators for a 3-month program of intensive diabetes care. Patients had at least weekly contact with a diabetes educator and received changes in insulin and/or other medication, coupled with extensive individualized instruction. The main outcome measurement was change in glycosylated hemoglobin (HbA1c) level at 3 months.
  
  
  RESULTS
  The first 350 patients who completed the program had overall mean decrease in HbA1c level of 1.7% (95% CI 1.4%-1.9%).
  
  
  CONCLUSIONS
  Barriers to improving glycemic control may be overcome by establishment of a system of collaboration between primary care providers and endocrinologist-directed diabetes educators.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Graber
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.forename: Doris
authors.initials: D
authors.lastname: Quinn
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wolff
authors.forename: Anne
authors.initials: A
authors.lastname: Brown
mesh_terms: D000328:Adult; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000451:nursing / Q000628:therapy*; D003927:Diet, Diabetic; D004704:Endocrinology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000592:standards; D010349:Patient Compliance; D010353:Patient Education as Topic; D010821:Physicians, Family; D015397:Program Evaluation; D012017:Referral and Consultation; D012044:Regression Analysis; D012648:Self Care
chemical_list: D006442:Glycated Hemoglobin