Changing the Process of Diabetes Care Improves Metabolic Outcomes and Reduces Hospitalizations

We designed and evaluated an ambulatory care intervention aimed at improving glycemic control and reducing hospitalizations in patients with insulin- dependent diabetes mellitus (IDDM). One hundred seventy-one youth with IDDM, ages 10–15, were assigned either to a Care Ambassador intervention (N = 89) or to standard care (N = 82). The intervention consisted of scheduling, confirming, and documenting medical follow-up for 24 months. During the study, the intervention group had more diabetes visits, 7.1 ± 1.50 (mean ± SD)Vs. 5.2 ± 2.57 in the standard care group (P = 0.0001). In the at-risk subjects (baseline HbA1c ≥8.1%, N = 162), 50% of intervention subjects compared with 29% of standard care achieved HbAlc ≤8.6% while 17% of intervention subjects compared with 32% of standard care had values >9.6% (P = 0.039). During follow-up, severe hypoglycemia and hospitalization/ER use occurred at half the rate in the intervention group compared with standard care. This specific, low-cost intervention aimed at increasing ambulatory medical visits in at-risk patients with diabetes improves metabolic outcomes and significantly reduces hospital/ER use.