Document Detail

Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial.
MedLine Citation:
PMID:  20513826     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Group medical clinics (GMCs) are widely used in the management of diabetes and hypertension, but data on their effectiveness are limited.
OBJECTIVE: To test the effectiveness of GMCs in the management of comorbid diabetes and hypertension.
DESIGN: Randomized, controlled trial. ( registration number: NCT00286741)
SETTING: 2 Veterans Affairs Medical Centers in North Carolina and Virginia.
PATIENTS: 239 patients with poorly controlled diabetes (hemoglobin A(1c) [HbA(1c)] level > or =7.5%) and hypertension (systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg).
INTERVENTION: 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. The pharmacist and physician adjusted medication to manage each patient's HbA(1c) level and blood pressure.
MEASUREMENTS: Hemoglobin A(1c) level and systolic blood pressure, measured by blinded research personnel at baseline, study midpoint (median, 6.8 months), and study completion (median follow-up, 12.8 months). Linear mixed models, adjusted for clustering within GMCs, were used to compare HbA(1c) levels and systolic blood pressure between the intervention and control groups.
RESULTS: Mean baseline systolic blood pressure and HbA(1c) level were 152.9 mm Hg (SD, 14.2) and 9.2% (SD, 1.4), 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 (P = 0.011 by linear mixed model), whereas mean HbA(1c) level improved by 0.8% in the GMC group and 0.5% in the usual care group (P = 0.159).
LIMITATION: Measurements of effectiveness may have been limited by concomitant improvements in the usual care group that were due to co-intervention.
CONCLUSION: Group medical clinics are a potent strategy for improving blood pressure but not HbA(1c) level in diabetic patients.
PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs Health Services Research and Development Service.
David Edelman; Sonja K Fredrickson; Stephanie D Melnyk; Cynthia J Coffman; Amy S Jeffreys; Santanu Datta; George L Jackson; Amy C Harris; Natia S Hamilton; Helen Stewart; Jeannette Stein; Morris Weinberger
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Annals of internal medicine     Volume:  152     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-01     Completed Date:  2010-06-14     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  689-96     Citation Subset:  AIM; IM    
Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA. <>
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MeSH Terms
Ambulatory Care / methods*,  organization & administration,  standards
Appointments and Schedules
Blood Pressure
Diabetes Mellitus, Type 2 / blood,  complications*,  therapy*
Group Processes*
Health Care Costs
Hemoglobin A, Glycosylated / metabolism
Hospitals, Veterans
Hypertension / complications*,  physiopathology,  therapy*
Outcome Assessment (Health Care)
Patient Care Team / standards
Patient Education as Topic
Self Care / standards
Reg. No./Substance:
0/Hemoglobin A, Glycosylated
Comment In:
Ann Intern Med. 2010 Oct 5;153(7):483; author reply 483   [PMID:  20921551 ]
Ann Intern Med. 2010 Jun 1;152(11):745-6   [PMID:  20513830 ]
Nat Rev Cardiol. 2010 Sep;7(9):478   [PMID:  20806463 ]

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