Shared doctor visits may help diabetes self-care

Diabetes patients who agreed to attend group medical appointments at a Veterans Administration hospital showed health improvements similar to what most diabetes drugs would achieve, according to U.S. researchers.

Getting type 2 diabetes patients to take care of themselves and manage their disease daily is a challenge for healthcare providers, but shared doctor visits could be a useful tool, the study team says.

One way that hasn't worked that well is to "lecture them," according to senior study author Dr. Jeffrey Kravetz of the VA Connecticut Health Care System.

"People learn from each other and it is easier to learn from people who are in the same boat," Kravetz said, adding that it is often more meaningful for people with diabetes to hear from a peer who understands the condition.

Type 2 diabetes can cause serious complications if it is not controlled by a combination of medication, diet and exercise. Healthcare providers agree the best way to approach this chronic condition is to educate patients to take care of themselves, but it's tough to get people to be better self-managers.

Kravetz, together with pharmacist Alexander B. Guirguis and a team that included a nurse who specializes in diabetes, a registered dietitian and a health psychologist, tried a different approach: shared medical appointments, in which groups of three to 10 patients met in a 90-minute session every six to 12 weeks for a year.

About one quarter of the 8,000 veterans who are seen in the Firm A clinic of the West Haven VA have diabetes, Kravetz and his team write in the American Journal of Medicine.

Around 300 of those patients have exceedingly high levels of a blood protein known as A1C that indicates how well blood sugar has been controlled over the preceding several months. A1C levels greater than 9 percent are considered problematic.

For the study, selected patients with A1C around 9 percent or more were invited to join a shared medical appointment for diabetes management. Before their first visit, the patients agreed to sharing their medical results with the group, and were sent "report cards" with their blood test results.

The 90-minute appointments combined education and consultations with the medical team with peer support and education. The emphasis, according to team leader Guirguis, was to try to make the sessions more "patient interactive as opposed to provider led."

The team would review patients' blood test results openly and encourage patients to talk about their challenges and successes. The sessions usually ended with a question and answer session and brief talk by the dietician.

Of the sixty patients who signed up, 40 attended at least two group visits, 19 attended three or more visits and 15 attended four shared medical appointments over the year. And by the study's end, some patients saw their A1C levels drop by as much as 1 percent, a change Kravetz says is about what would be expected from medication.