Team-Based Care to Improve Diabetes Management: A Community Guide Meta-analysis

• Type of Material: Article
• Authors: Timothy W. Levengood, Division of Public Health Information Dissemination; Yinan Peng, Division of Public Health Information Dissemination; Ka Zang Xiong, Division of Public Health Information Dissemination; Ziwei Song, Division of Public Health Information Dissemination; Randy Elder, Division of Public Health Information Dissemination; Mohammed Ali, Emory University; Marshall H. Chin, University of Chicago; Pamela Allweiss, Centers for Disease Control and Prevention; Christine M. Hunter, National Institutes of Health; Alberta Becenti, Indian Health Services
• Language: English
• Date: 2019-07-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2019.02.005
• Title of Journal or Parent Work: American Journal of Preventive Medicine
• Volume: 57
• Issue: 1
• Start Page: E17
• End Page: E26
• Grant/Funding Information: The work of Timothy Levengood and Ka Xiong was supported with funds from the Oak Ridge Institute for Science and Education.; Mohammed Ali was partially supported by Georgia Center for Diabetes Translation Research (P30DK111024).; Marshall Chin was supported in part by the Chicago Center for Diabetes Translation Research (National Institute of Diabetes and Digestive and Kidney Diseases P30 DK092949).
• Keywords: Public, Environmental & Occupational Health; Blood-pressure control; African-Americans; General & Internal Medicine; Life Sciences & Biomedicine; Randomized trial; Medicine, General & Internal; Pharmacist; Outcomes; Mellitus; Cardiovascular risk; Health worker team; Glycemic control; Nurse case-management; Science & Technology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Health Care Management; Psychology, Behavioral; Health Sciences, Public Health

Abstract

Context Team-based care has been increasingly used to deliver care for patients with chronic conditions, but its effectiveness for managing diabetes has not been systematically assessed. Evidence acquisition RCTs were identified from two sources: a high-quality, broader review comparing 11 quality improvement strategies for diabetes management (database inception to July 2010), and an updated search using the same search strategy (July 2010–October 2015). Evidence synthesis Thirty-five studies were included in the current review; a majority focused on patients with Type 2 diabetes. Teams included patients, their primary care providers, and one or two additional healthcare professionals (most often nurses or pharmacists). Random effect meta-analysis showed that, compared with controls, team-based care was associated with greater reductions in blood glucose levels (−0.5% in HbA1c, 95% CI= −0.7, −0.3) and greater improvements in blood pressure and lipid levels. Interventions also increased the proportion of patients who reached target blood glucose, blood pressure, and lipid levels, based on American Diabetes Association guidelines available at the time. Data analysis was completed in 2016. Conclusions For patients with Type 2 diabetes, team-based care improves blood glucose, blood pressure, and lipid levels.