Nicole Handlow: Impact of Multidisciplinary Team on Glycemic Control

A study presented at the American Diabetes Association 2019 Scientific Sessions in San Francisco, CA found that a multidisciplinary team approach in primary care settings can help patients have greater glycemic control.

To examine the impact of such a team, which consisted of a provider, pharmacist, dietician, and behavioral health specialist, investigators retrospectively analyzed the results of their own 12-week diabetes program.

The program took place from Jan. to Aug. 2018 across 3 primary care locations and included 85 participants. The primary outcome was mean change in HbA1c and secondary outcomes included 24-week HbA1c change, mean change in blood pressure, weight, and the Diabetes Distress Scale score.

At the 3-month follow-up, investigators noted a significant decrease in mean HbA1c (2.1+/-2.3, p < 0.001), a total of 54.1% of patients met their A1c goal, and the mean change in weight (kg) was -1.96+/- 3.9 (p = 0.001) from baseline.

Lead author Nicole Handlow, of Allegheny General Hospital, sat down with MD Magazine® to discuss the results of the study and the biggest obstacles in primary care that would hamper the implementation of a similar team

MD Mag: What was the impact of having a multidisciplinary team on glycemic control in a primary care setting?

Handlow: So, where the study originated from was two endocrinology offices within our network where we had this team-based approach with an endocrinologist, a pharmacist, a behavioral health specialist, as well as a dietitian and it was a 12-week program where patients had initial appointment and they met with each member of the team and then following that appointment they had 12 weeks of follow-up based on their needs.

So, majority of patients followed up with the pharmacist to optimize medication or the dietician because a lot of dietary improvement was needed and then they returned in 12 weeks for a follow-up appointment to get repeat a1c's and other lab values as well as to meet with everyone on the team and we didn't find quite significant results.

Our primary objective was looking at reduction in a1c. So, most patients showed a median reduction of 1.3 but we also broke it down further into those who started with a higher a1c. So, if they had an a1c of greater than 9, which majority of patients did, we actually found a reduction of 3.1 for a1c and then we looked at other variables as well so we looked at those on statin therapy at baseline 3-month follow-up and it was found to be statistically significant that we increased the number of those on appropriate statin therapy — as well as aspirin therapy in combination also with the diabetic distress scale score. So, it's multifactorial that there's improvements in all these categories. So, overall the goal is then to try to roll this out further into other primary care sites based on the success we've had.

MD Mag: What is the biggest challenge a team could face when looking to implement this approach?

Handlow: I think probably the biggest challenge is just initiating these teams. So, right now most of the primary care sites only have a physician or a nurse practitioner or PA. So, the goal really is to start transforming these sites to have a pharmacist, to have a dietician, to have a behavioral health specialist and once that team is intact then it becomes more of a challenge of building it into workflow.

So, for the current clinics it was only one day a week that the program was implemented. So, we would see 4 to 5 patients that were new to the program each week because schedules are already full for most providers. So, it was just really trying to figure out the best day or time for that program to be started.