Diabetes: Translating the chronic care model into the community

Educating people with diabetes in a primary-care setting with sustained, comprehensive intervention resulted in significant improvement in disease management and overall health, according to a study published in the current issue of Diabetes Care, a journal of the American Diabetes Association (ADA).

In the study, University of Pittsburgh Diabetes Institute researchers report the first evidence from a randomized, controlled clinical trial to show a clear association between a more comprehensive approach to diabetes management and improved health.

"Patients who received the chronic care model, or CCM, intervention experienced substantial improvements both physically and psychologically," said Gretchen Piatt, M.P.H., a doctoral candidate in the department of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH) and the study's first author. "As a result of this study, the University of Pittsburgh Medical Center has redesigned the way in which diabetes care is delivered."

Using state-of-the-art education and other training tools, the CCM was designed to guide systematic efforts to improve health care for people with chronic illness. The idea is to motivate patients, caregivers and health care professionals to work as a team toward a goal of better outcomes.

"Not everyone will be able to see a diabetes specialist," noted Janice Zgibor, Ph.D., senior author of the study, assistant professor of epidemiology at GSPH and director of evaluation at the University of Pittsburgh Diabetes Institute. "Most people with diabetes, especially those in smaller communities, are managing their illness in the primary-care setting. The CCM intervention gives them, and their providers, better tools with which to do this."

The study involved diabetic patients who visited 11 primary care physician practices located in one of Pittsburgh's eastern suburbs between 1999 and 2003. The 11 practices encompassed 24 health care professionals providing care for a primarily elderly, disadvantaged population with a higher incidence of chronic illness compared to the general population. Physician practices were randomized to the CCM intervention, provider education about diabetes or standard diabetes care. Ultimately, 119 patients took part in the study - 30 receiving the CCM intervention, 38 whose providers received a single diabetes education session and the remaining received standard care.

In the CCM intervention group, in which patients and their providers received diabetes-control education, there were significant improvements in clinical, behavioral and psychological indicators compared to the other patient groups. For example, several important indicators of diabetes control, including average blood glucose measures, levels of HDL (good) cholesterol and non-HDL (bad) cholesterol and knowledge about diabetes control, improved significantly for patients receiving the CCM intervention but were little changed in the other two groups.