Clinical Medicine Insights: Endocrinology and Diabetes

Objectives: To investigate whether planned visits improve glycemic, blood pressure and lipid control among patients with type 2 diabetes mellitus (DM).

Methods: The study was conducted from July 2007 to February 2008 at a primary care clinic in Rancho Cordova, California. One hundred eighty-three patients were invited to come to a planned visit. On the day of the visit, they were provided a copy of their most recent test results and information on American Diabetes Association recommendations for A1C, lipid, and blood pressure control. Afterwards, they met with their physician for a 15-minute focused appointment. Finally, they met with a diabetic nurse educator. There was no subsequent contact with the nurse educator after the planned visit. We compared the baseline measurements to those from a follow-up visit with the primary care provider at a follow-up over a 6 month period. The comparison group in this study were those who did not accept the invitation for a planned visit. Their outcomes were monitored over the same time horizon.

Results: One hundred eighty-three patients attended one of a total of five planned visit sessions. There were 212 patients in the comparison group. There were no significant differences for the measured baseline characteristics. There were significant improvements in A1C, LDL-C, and diastolic blood pressure control in the planned visit group. The mean A1C change was −0.61% (95% confidence interval, −0.28, −0.70); P 0.001). The mean LDL-C change was −8.8 mg/dL (95% confidence interval, −12.2, 6.1); P 0.05. The mean diastolic blood pressure change was −2.0 mmHg (95% confidence interval, −4.7, 6.7); P 0.05. Patients who participated in a planned visit also reported a significantly higher frequency of self-care behaviors and greater understanding about diabetes care.

Discussion: Planned visits led to improvements in glycemic, lipid and blood pressure control over a 6 month observation period. Patients attending planned visits also reported improvements in self-care behaviors and a greater understanding about diabetes care.