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The MedStar Diabetes Institute (MDI), in partnership with key MedStar Health system diabetes stakeholders, seeks to implement an evidence-based innovative integrated care pathway for MedStar patients with uncontrolled diabetes which will demonstrate improvement in diabetes care outcomes.
- The program is designed to bring diabetes specialty services to Primary Care practices to support PCPs and their patients in improving diabetes-related outcomes.
- High-risk patients from MedStar Primary Care practices who have uncontrolled type 2 diabetes and meet the target population inclusion and exclusion criteria will be invited to participate in an intensive and concise medication management and education intervention of ~4-8 weeks duration.
- The intervention will consist of three key components: (1) intensive, algorithm-based medication management (Appendix A), based on continuous review and management of blood sugars; (2) survival skills diabetes self-management education; (3) enhanced patient-provider communication, all provided by Endocrinologist supervised allied health professionals (in this instance CDEs).
- Survival skills DSME will focus on nutrition and meal plan basics, blood glucose targets, taking medications as prescribed, hyper- and hypoglycemia recognition and treatment, and when to seek medical help.
- The intervention will start with one to two face-to-face meetings with the CDE, to be followed by virtual meetings though a variety of media based on patient preference and health literacy.
- Various technology tools will be used to facilitate patient engagement and attainment of glycemic targets, including smart meters, virtual meeting platforms, web-based education content and surveys via tablets, etc.
- Concurrent matched charts of patients receiving standard care at the three MedStar locations will serve as a basis of comparison in assessing the impact of MDI on clinical and education outcomes and process of care.
- Based on patient progress towards improved glycemic control, the patient will 'graduate' from the program and the CDE will refer the patient back to their PCP in 8-12 weeks with a full report of medication changes, blood glucose readings and further diabetes management recommendations eg referrals; further DSME, etc.
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Active, not recruiting
Medstar Health Research Institute
Published on BioPortfolio: 2016-10-06T00:38:21-0400
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The time period before the development of symptomatic diabetes. For example, certain risk factors can be observed in subjects who subsequently develop INSULIN RESISTANCE as in type 2 diabetes (DIABETES MELLITUS, TYPE 2).
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The state of PREGNANCY in women with DIABETES MELLITUS. This does not include either symptomatic diabetes or GLUCOSE INTOLERANCE induced by pregnancy (DIABETES, GESTATIONAL) which resolves at the end of pregnancy.
Excessive thirst manifested by excessive fluid intake. It is characteristic of many diseases such as DIABETES MELLITUS; DIABETES INSIPIDUS; and NEPHROGENIC DIABETES INSIPIDUS. The condition may be psychogenic in origin.
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