ADA Abstract Number: 0339-OR

Authors:

GARRY WELCH, PAULA SANTIAGO-KELLEY, ZORAIDA CRESPO, SOFIJA ZAGARINS, JANE GARB, RICHARD KEDZIORA, Springfield, MA, Conshohocken, PA

Abstract

We piloted a culturally sensitive diabetes case management tool (Comprehensive Diabetes Management Program, CDMP) based on the Chronic Care Model in an urban community health center. Self management support included use of the Diabetes Self Care Profile (DSCP), a web-based diabetes self management assessment program. The CDMP provides standard clinical algorithms, clinical decision support, treatment guidelines with customizable alerts, and reminders. The CDMP integrates the Joslin Vision Network eye screening telemedicine system and its nonmydriatic (non-dilated eye) camera, and standardized retinopathy reading at the Joslin Diabetes Center, Boston, Ma. PCPs receive a regular summary report of the CDMP findings from study case managers to support practice guideline adherence. Forty eligible patients (Hispanic, Type 2, poor bg control with A1c 7.5% or higher) were randomized to case management intervention (CMI) or attention control (AC).The sample was 67% female, mean age 57 yrs., 61% had diabetes [gt]10 years. In year prior to randomization, 40% had [gt]=1 ER visit, 35% a foot exam, 23% an eye exam. CMI patients received 9 individual 1 hour visits to the CMI team (Hispanic diabetes nurse and dietitian) over one year. We report here 6 month findings only. Attention control received 6 individual visits with lay clinic staff trained to discuss standardized diabetes education materials. Results showed that HbA1c was significantly lowered for the CMI group as compared to AC (-1.2% [plusmn]1.4 vs. -0.07%[plusmn]1.0, p[lt]0.02). Systolic and diastolic blood pressure were also significantly lowered for CMI (both p[lt]0.02). Yield for the JVN eye screening showed 26.3% of CMI pts. required treatment follow-up for retinopathy or macular edema. DSCP results showed 87.5% of CMI pts. reported one or more psychosocial barriers at baseline. High diabetes emotional distress (Problem Areas In Diabetes, PAID score [gt]=50) was found for 66.6%, major depression (using PHQ) for 52.3%, hypglycemia for 57.1%, binge eating for 28.6%, low social support for 23.8%, and alcohol abuse (using CAGE) 0%. PAID change scores were significantly lowered (improved) for CMI (-11.8 [plusmn]24.8) and increased for AC(+4.4[plusmn]21.2)(p[lt]0.03). Overall, our 6 month CDMP pilot data showed improved clinical and psychosocial outcomes, successfully identified pts.requiring treatment for retinopathy and identified a high proportion of pts.with psychosocial barriers to self management.