A New Approach to Care Management in Uncontrolled Type 2 Diabetes

Data are limited on meaningful improvements associated with type 2 diabetes care management (DCM) in clinical care settings. In this study, researchers created and implemented a Boot Camp approach to DCM, evaluating its effects on hemoglobin A1c (HbA1c), emergency department (ED) visits, and hospitalizations in patients with uncontrolled type 2 diabetes. The intervention enrolled adult patients with HbA1c >9% (75 mmol/mol) between November 2014 and November 2017. Diabetes educators and nurse practitioners provided disease education and medication management, first through a clinic visit and subsequently through weekly virtual visits; near-real-time blood glucose transmission was facilitated for 90 days. Outcomes considered included 90-day HbA1c and ED visit and hospitalization risks, as well as potential savings through reduced medical utilization. A total of 366 patients who completed the intervention were propensity-matched 1:1 to controls receiving usual care at primary care practices. The case and control groups had similar baseline mean HbA1c levels (11.2% [99 mmol/mol] vs. 11.3% [100 mmol/mol]). After 90 days, HbA1c was reduced in both groups (8.1% [65 mmol/mol] vs. 9.9% [85 mmol/mol], respectively); 90-day all-cause hospitalization risk decreased by 77% for cases and increased 58% for controls. Each Boot Camp patient saved the health system a mean $3,086 annually in averted hospitalization costs.