3-year follow-up of clinical and behavioral improvements following a multifaceted diabetes care intervention: results of a randomized controlled trial.
The purpose of this study was to determine if improvements observed in clinical, behavioral, and psychosocial outcomes measured at 12 months following a multifaceted diabetes care intervention were sustained at 3-year follow-up.



This study was a multilevel, nonblinded, cluster design, randomized controlled trial that took place in an underserved suburb of Pittsburgh, Pennsylvania, between 1999 and 2005. Eleven primary care practices, and their patients, were randomly assigned to 3 groups: chronic care model (CCM) intervention (n = 30), provider education only (PROV) (n = 38), and usual care (UC) (n = 51). Subjects were followed for 3 years.



Improvements observed at 12-month follow-up in glycemic (-0.5%) and blood pressure control (-4.8 mm Hg), and the proportion of participants who self-monitor their blood glucose (86.7%-100%), were sustained at 3-year follow-up in the CCM group. Additional improvements occurred in non-HDLc levels in all study groups and quality of well-being scores in the CCM intervention group. All associations remained after controlling for medication treatment intensification.



We have demonstrated that improvements in outcomes can be sustained over time following a multifaceted diabetes care intervention. Future research in this area is necessary to understand if improvements in outcomes can be sustained following diabetes self-management education (DSME) and what type of patient fares the best from multifaceted diabetes care interventions.
Piatt
Gretchen A
GA
The Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Piatt, Dr Siminerio, Dr Korytkowski)
Anderson
Robert M
RM
The Department of Medical Education, University of Michigan, Ann Arbor, Michigan (Dr Anderson)
Brooks
Maria M
MM
The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Brooks, Dr Songer, Dr Zgibor)
Songer
Thomas
T
The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Brooks, Dr Songer, Dr Zgibor)
Siminerio
Linda M
LM
The Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Piatt, Dr Siminerio, Dr Korytkowski)
Korytkowski
Mary M
MM
The Division of Endocrinology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Piatt, Dr Siminerio, Dr Korytkowski)
Zgibor
Janice C
JC
The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Brooks, Dr Songer, Dr Zgibor)
D000368:Aged; D015190:Blood Glucose Self-Monitoring; D001794:Blood Pressure; D016000:Cluster Analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010353:Patient Education as Topic; D010414:Pennsylvania; D012648:Self Care; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors
D006442:Glycated Hemoglobin