CDE 'ambassadors' improve diabetes care
NASHVILLE, Tenn. — Certified diabetes educators trained by and working under the guidance of endocrinologists helped patients in a primary care setting improve glucose, lipid and body weight measures after 5 months.
“A properly trained … certified diabetes educator can improve [diabetes] control, and this we think might be the way of improving the health of the diabetic in the community. There are very few other options,” said Sandeep Dhindsa, MD, head of endocrinology at Texas Tech University said. Dhindsa presented for Paresh Dandona, MD, chief of endocrinology at the State University of New York at Buffalo at a press conference.
Dandona and colleagues provided a 3-month training program for two certified diabetes educators (CDEs), in which the CDEs saw patients and reviewed cases with endocrinologists. These CDE “ambassadors” took their knowledge to a primary care practice in Buffalo.
To assess the effect on outcomes of the additional training, Fida Al-Atrash, MD, also of SUNY Buffalo, and colleagues conducted a chart review of patients with type 2 diabetes at the primary care practice. They compared data from 100 patients who received counseling from a CDE ambassador with 45 patients who spent no time with a CDE. Most patients seeing a CDE ambassador met with that person twice. The study ran from the first CDE ambassador visit until follow-up with the primary care provider; average follow-up time was 4.6 months. None of the patients consulted with an endocrinologist.
The CDE ambassador group experienced a mean reduction in HbA1c from 8.4% to 6.8%; body weight decreased from 102 kg to 99 kg, and BMI dropped by 0.96 (P < 0.0001 for all). Systolic blood pressure also decreased from 134 mm Hg to 128 mm Hg and diastolic from 80 mm Hg to 77 mm Hg (P < 0.005 for both). These patients also saw improvements in lipids: LDL decreased from 108 mg/dL to 96 mg/dL and triglycerides from 189 mg/dL to 162 mg/dL (P < 0.005). Urine microalbumin to creatinine ratio also dropped from 64 ± 536 mg/g to 27 ± 153 mg/g (P = 0.33).
During the same period, no significant changes were observed in these measures for the patients who did not see a CDE ambassador.
Researchers attributed the improvements seen in the CDE ambassador patients to changes in diet and drug therapies that optimized diabetes medications. No changes were made to statin prescriptions during the study; lipid improvements were likely the result of better adherence, according to researchers.
“We are now contemplating [conducting] prospectively randomized studies comparing centers which are supported with [certified diabetes educator ambassadors] with those that are not and to study the durability of and cost saving related to these effects,” the researchers concluded. — by Jill Rollet
Al-Atrash F, et al. Abstract #275. Presented at: AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2014; Nashville, Tenn.
Disclosure: The researchers report no relevant financial disclosures.