Joint Diabetes Project Extends Diabetes Care

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WASHINGTON, DC—A joint project between Wilford Hall Medical Center (WHMC) and the University of Pittsburgh Medical Center (UPMC) has made a positive difference in diabetes care for military patients, dependents, and retirees, according to Maj Brian Allenbrand, an endocrinology flight commander at WHMC.

AF-diabetes.jpgWHMC has been implementing and partnering in diabetes research with UPMC that was made possible with congressional funding. The late Rep John Murtha from Pennsylvania sponsored funding for the project because of his concern about the state of diabetes care in the US, Allenbrand explained. “With it being a joint DoD grant, the Air Force was a co-researcher and an end product user of the research being done at the University of Pittsburgh.”

Diabetes Patients

Just as the civilian sector must grapple with diabetes, so does the military. Allenbrand explained that there are a substantial number of Tricare diabetic patients in the local San Antonio area, including active duty, retirees, and military dependents. “I believe our diabetic population is about 9,000 in the San Antonio area here, and that is all people eligible for care through Tricare, both Army and Air Force.”

One important initiative of the joint project has been the establishment of a diabetes center of excellence at WHMC for outpatient care that has been manned by UPMC and WHMC staff.

The center uses a chronic care management team approach adopted from the University of Pittsburgh to treat and manage diabetes. The center’s approach allows the patient to receive the diabetes services needed in a single location. “When a patient comes in for a diabetes visit it is kind of a one-stop shop model for them. They are able to see the provider and have adjustments made to their medications. They are then able to see the nurse educator to receive the education they need to reinforce the changes that were made by the clinician. They can have their retinal imaging done if they are due for that while they are here, as well as to see a dietician and or a counselor,” Allenbrand stated.

In addition, the congressional funding has made it possible for a team of educators, dieticians, and different specialties to visit outlying DoD facilities and assist with diabetes clinics and diabetes care at these facilities as well.

Part of the original vision of establishing the diabetes center was to determine if the chronic care team approach for diabetes care used at the center is a good working model, Allenbrand noted. “We believe it has been a good working model here. So our hope is that this model would be exported to other larger Air Force facilities around the country, which would then operate diabetes centers for their local areas, providing support to their smaller MTFs.”

Allenbrand said that the center has extended the diabetes care that is provided at WHMC. “Our appointments have increased significantly. ”

In addition, he said that over the last year in which the diabetes center has been fully operational, researchers have seen an average hemoglobin A1C drop of about 1% in the entire population followed. “As we collect data, we hope to present that to leadership to present this as a model they can use.”

Allenbrand said that they are currently seeking permanent funding for the center since congressional funding for the outpatient and prevention function of the joint project will come to a conclusion in January. While the diabetes center will continue to exist, there will be a significant reduction in staffing without new funding. “We are actually pursuing a more permanent funding of some of the positions so we can keep the same volume that we have had. That request is still in
the works.”

Glycemic Control

On the inpatient side, the collaboration has also resulted in the development of a glycemic management team model and the adoption of glycemic management protocols designed by UPMC.

Allenbrand explained that the glycemic management team reviews blood sugar levels of patients that have been downloaded into a central database at WHMC. “All of the blood sugars that are done in the hospital are downloaded into a central database, and they receive reports from that. From that they are able to identify
patients who are having problems with either hyperglycemia or hypoglycemia, and then [the team] makes rounds and writes recommendations to the physician providers on these patients for what they can do to target the problem they have identified.”

More than 90% of the recommendations made by the glycemic management team have been accepted and implemented by providers, which Allenbrand said was very good. “This is a model that is being developed in a lot of civilian facilities right now, and acceptance rates for recommendations by midlevel providers on the floor are typically not that high.”

The team also provides patient education, especially to patients in the hospital who are starting insulin, as well as educating all of the nurses and physicians about the glycemic management protocols used on the floor.

The glycemic management protocols have been very helpful in enhancing glycemic control in the hospital by standardizing care, according to Allenbrand. “We had a lot of hyperglycemia that was undertreated, and a lot of episodes of hypoglycemia because of inappropriate insulin regimens. So the protocols have really helped to standardize treatment. They assist providers in choosing insulin regimens that are more appropriate to their patients and that has really helped to smooth out the large differences we were seeing before the protocols.”

Allenbrand said that the facility is now in the process of sharing the protocols and the glycemic management team model with other medical facilities in the Air Force.

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