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Publication Date

7-13-2010

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Advisor: Mona Sarfaty, MD, FAAFP-Thomas Jefferson University

Abstract

The purpose of this study was to determine how the DISH program affected medication prescribing and intermediate outcomes of diabetes care in the JFMA practice. A matched comparison group design was used to compare the change from baseline in the proportion of DISH program participants and non-participants who achieved a hemoglobin A1c < 7%, < 8% and > 9%; a low density lipoprotein (LDL) blood concentration < 130 mg/dL and < 100 mg/dL; a blood pressure (BP) < 140/90 mm Hg and < 130/80 mm Hg, and weight loss during the follow-up period. DISH participants were matched to non-participants on age category, gender, race/ethnicity and zip code group, a surrogate marker for socioeconomic status. DISH participants attended at least one program session between measurement of outcome variables in the baseline and follow-up periods. The distribution of demographic characteristics and co-morbidities was similar between the DISH and comparison groups. The median number of DISH sessions participants attended was 1. Forty-six percent attended at least 3 of 4 sessions. A statin, and either an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker were prescribed for a similar proportion of patients in both groups. The proportion of DISH participants achieving a BP < 140/90 mm Hg increased compared to the comparison group (CMH=3.99, p=0.046) and after controlling for baseline BP (CMH =5.61, p=0.018). The increase in the proportion of DISH participants achieving the target A1c (CMH= 2.97, p=0.085 for A1c < 7% adjusted for baseline) and LDL concentrations did not achieve the 0.05 level of significance. . The difference between the groups in the proportion of diabetics who lost weight was not significant, although the median weight change in the DISH group was greater (-3.5 pounds vs. -1 pound). Participation in the DISH program was associated with improvement in blood pressure control.

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