Change in Glycemic Control for Patients Enrolled in a Membership-Based Primary Care Program: Longitudinal Observational Study

Lenard I Lesser; Raj Behal

doi:10.2196/27453

Change in Glycemic Control for Patients Enrolled in a Membership-Based Primary Care Program: Longitudinal Observational Study

JMIR Diabetes. 2021 Jun 11;6(2):e27453. doi: 10.2196/27453.

Authors

Lenard I Lesser¹, Raj Behal¹

Affiliation

¹ One Medical, San Francisco, CA, United States.

PMID: 33999830
PMCID: PMC8235285
DOI: 10.2196/27453

Abstract

Background: Both primary care practices based on the chronic care model (CCM) and digital therapeutics have been shown to improve the care of patients with diabetes.

Objective: The aim of this observational study was to examine the change in diabetes control for patients enrolled in a membership-based primary care service that is based on the CCM.

Methods: Using a diabetes registry, we analyzed the change in glycated hemoglobin (HbA_1c) for patients with uncontrolled diabetes mellitus (initial HbA_1c≥9%). All patients had access to a technology-enhanced primary care practice built on the CCM.

Results: The registry included 621 patients diagnosed with uncontrolled diabetes. All patients had at least two HbA_1c measurements, with the average time between the first and last measurement of 1.2 years (SD 0.4). The average starting value of HbA_1c was 10.7, which decreased to 8.7, corresponding to a reduction of 2.03 (P<.001). Secondary analyses showed statistically significant reductions in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides.

Conclusions: Patients with initially uncontrolled diabetes who undergo care in a technology-enhanced primary care practice based on the CCM have long-term clinically meaningful reductions in HbA_1c.

Keywords: chronic care model; clinical information system; decision support; decision-making; diabetes; diabetes mellitus; digital health; observational; patient; primary care; self-management.