Can group medical clinics improve lipid management in diabetes?
BACKGROUND
Group medical clinics may improve diabetes and hypertension control, but data about dyslipidemia are limited. We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension.


METHODS
Prespecified secondary analysis of 239 veterans randomized to group medical clinics or usual care. Lipids were assessed at study baseline, midpoint, and end. We used linear mixed models to compare lipid levels between arms and generalized estimating equation models to compare low-density lipoprotein cholesterol (LDL-C) goal attainment. An additional post hoc analysis examined intensification of cholesterol-lowering medications in both arms.


RESULTS
At baseline, mean total cholesterol was 169.7 mg/dL (SD 47.8), LDL-C 98.2 mg/dL (SD 41.7), and high-density lipoprotein cholesterol (HDL-C) 39.3 mg/dL (SD 13.0). Median baseline triglycerides were 131 mg/dL (interquartile range 122). By study end, mean total cholesterol and LDL-C in group medical clinics were 14.2 mg/dL (P = .01) and 9.2 mg/dL (P = .02) lower than usual care, respectively; 76% of group medical clinic patients met goals for LDL-C, versus 61% of usual care patients (P = .02). Triglycerides and HDL-C remained similar between study arms. Treatment intensification occurred in 52% of group medical clinic patients, versus 37% of usual care patients between study baseline and end (P = .04). The mean statin dose was higher in group medical clinic patients at study midpoint and end.


CONCLUSIONS
Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension. This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care.
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Duke University, Durham, NC. Electronic address: matthew.crowley@dm.duke.edu.
Matthew J
MJ
Crowley
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.
Stephanie D
SD
Melnyk
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC.
Jared L
JL
Ostroff
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va.
Sonja K
SK
Fredrickson
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
Amy S
AS
Jeffreys
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
Cynthia J
CJ
Coffman
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC.
David
D
Edelman
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001384:Azetidines / Q000627:therapeutic use; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy*; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014728:Veterans
D000924:Anticholesteremic Agents; D001384:Azetidines; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe
Clinical inertia; Diabetes; Dyslipidemia; Group medical clinics; Treatment intensification