Multidisciplinary group behavioral and pharmacologic intervention for cardiac risk reduction in diabetes: a pilot study.
The purpose of this study was to evaluate the effectiveness of a multidisciplinary team providing both education and medication management in a group setting for cardiac risk reduction in patients with diabetes mellitus.



The electronic medical records of patients with diabetes who participated in group behavioral and pharmacologic interventions for cardiac risk reduction during May to October 2002 at the Providence VA Medical Center were reviewed. Forty-one veterans with diabetes mellitus attended the weekly sessions of a diabetes education and intervention program directed by pharmacists for 1 month. Two groups of 15 to 20 patients received four 1.5-hour diabetes self-management education classes provided by a multidisciplinary team consisting of a pharmacist (leader), nurse educator, dietician, physical therapist, and social worker and four 1-hour group medication adjustment sessions provided by the pharmacist. Pharmacists followed medication adjustment algorithms for blood pressure, diabetes, and cholesterol management previously developed in collaboration with physician specialists in the field. Baseline and 3-month after-intervention data were collected for glycosylated hemoglobin A1C (A1C), systolic and diastolic blood pressure (SBP and DBP, respectively), low-density lipoprotein cholesterol, and body mass index.



Thirty-six patients attended 4 sessions, and 5 patients attended 3 sessions. All parameters improved after the intervention, with significant reductions in A1C (-1.5% +/- 1.0%) and DBP (-5 mm Hg). Reductions were further accentuated when baseline values were abnormal, with significant improvement in A1C (-2.0% +/- 0.5%), SBP (-14 +/- 3 mm Hg), and DBP (-13 +/- 3 mm Hg).



Short-term multidisciplinary group behavioral and pharmacologic intervention programs may be effective in improving cardiac risk factors in patients with diabetes.
Martin
Oanh J
OJ
Pharmacy Service, Veterans Affairs Medical Center, and the Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Providence VA Medical Center, Providence, Rhode Island (Dr Martin)
Wu
Wen-Chih
WC
Medical Service, Veterans Affairs Medical Center, Providence VA Medical Center, and Brown Medical School, Brown University, Providence, Rhode Island (Dr Wu, Dr Sharma)
Taveira
Tracey H
TH
Pharmacy Service, Veterans Affairs Medical Center, and the Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy (Dr Taveira)
Eaton
Charles B
CB
The Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island, and the Department of Family Medicine, Brown Medical School, Brown University, Providence, Rhode Island (Dr Eaton)
Sharma
Satish C
SC
Medical Service, Veterans Affairs Medical Center, Providence VA Medical Center, and Brown Medical School, Brown University, Providence, Rhode Island (Dr Wu, Dr Sharma)
D003925:Diabetic Angiopathies / Q000517:prevention & control* / Q000534:rehabilitation; D006331:Heart Diseases / Q000517:prevention & control* / Q000534:rehabilitation; D006801:Humans; D008499:Medical Records; D010348:Patient Care Team; D010353:Patient Education as Topic; D018579:Patient Selection; D010865:Pilot Projects; D040242:Risk Reduction Behavior