Group care for patients with uncontrolled DM2 and hypertension

January 01, 0001

Group care for patients with uncontrolled DM2 and hypertension

These US investigators conducted a randomized controlled trial to test the effectiveness of group medical clinics (GMCs) in the management of comorbid diabetes and hypertension. They included 239 patients with poorly controlled diabetes (HbA1c level greater than 7.5%) and hypertension (systolic blood pressure greater than 140 mm Hg or diastolic blood pressure greater than 90 mm Hg). Patients were randomly assigned within each center to either attend a GMC or receive usual care. Clinics comprised 7 to 8 patients and a care team that consisted of a primary care general internist, a pharmacist, and a nurse or other certified diabetes educator. Each session included structured group interactions moderated by the educator.

They found: "Mean baseline systolic blood pressure and HbA1c level were 152.9 mm Hg and 9.2%, respectively. At the end of the study, mean systolic blood pressure improved by 13.7 mm Hg in the GMC group and 6.4 mm Hg in the usual care group, whereas mean HbA1c level improved by 0.8% in the GMC group and 0.5% in the usual care group (NS)."

The authors concluded: "Group medical clinics are a potent strategy for improving blood pressure but not HbA1c level in diabetic patients."

This degree of improvement in blood pressure may warrant the group approach in some cases.

For the full abstract, click here.

Annals of Internal Medicine 152(11):689-696, 1 June 2010 © 2010 to the American College of Physicians
Medical Clinics Versus Usual Care for Patients With Both Diabetes and Hypertension: A Randomized Trial. David Edelman, Sonja K. Fredrickson, Stephanie D. Melnyk, et al. Correspondence to Dr. Edelman: [email protected]

Category: HSR. Health Services Research, T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: diabetes type 2, hypertension, blood pressure, HbA1c, group clinics, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.