Patient Care Teams

The need for multidisciplinary teams in diabetes is demonstrated by the diversity of markers of quality care for diabetics, which at a minimum, include glycemic control, blood pressure control, and lipid control^[2][3][4].

Additional markers of quality of care include cessation of tobacco use, serial eye and dental examinations, foot examination, and vaccinations^[3], as well as renal monitoring for albuminuria^[4].

Achieving these goals is difficult with typical rates of success:

• 21.2% of American adults in 2015-2018 achieved all three goals per NHANES data (individualized HbA1c targets [“less than 6.5% for young adults aged 18 to 44 years without complications, less than 7.0% for both young adults with complications and middle-aged adults aged 45 to 64 years without complications, less than 8.0% for both middle-aged adults and older adults aged 65 years or older with complications, and less than 7.5% for older adults without complications.”], blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL)^[4]
• 22.2% of American adults in 2015-2018 achieved all three goals per NHANES data in a second study (HbA1c <7%, non-high-density lipoprotein cholesterol level, <130 mg per deciliter, blood-pressure control <140/90 mm Hg)^[3]

18.2% (vs. 8.1%% in usual care) of patients achieved control of glycemic, blood pressure (“HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL”), and LDL goals in a randomized controlled trial of patient care teams in an international study of patients with “poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL).”^[5]. These rates were lower than in a prior study of Kaiser^[6].

The impact of patient care team and many other quality improvement efforts to improve the care of diabetes patients have been systematically reviewed^[7].