DURHAM, NC — How effective are group medical appointments for improving dyslipidemia in veterans with uncontrolled diabetes and hypertension?
A recent study led by researchers from the Center for Health Services Research in Primary Care at the Durham, NC, VAMC and Duke University sought to answer that question. Their results were published recently in the American Journal of Medicine
For the research, 239 veterans were randomized to group medical clinics or usual care, with lipids assessed at study baseline, midpoint and end.
At baseline, mean total cholesterol was 169.7 mg/dL (SD 47.8), LDL-C 98.2 mg/dL (SD 41.7); high-density lipoprotein cholesterol (HDL-C) 39.3 mg/dL (SD 13.0), and median triglycerides were 131 mg/dL (interquartile range 122).
By the end of the study, however, mean total cholesterol and LDL-C in group medical clinics were 14.2 mg/dL (P
= 0.01) and 9.2 mg/dL (P
= 0.02) lower than usual care, respectively. Furthermore, 76% of group medical clinic patients met goals for LDL-C, vs. 61% of usual-care patients (P
Triglycerides and HDL-C remained similar between the intervention and control groups.
One reason for the difference could be related to treatment intensification, according to study authors, noting that occurred in 52% of group medical clinic patients compared with 37% of usual care patients between study baseline and end. Overall, the mean statin dose was higher in group medical clinic patients at study midpoint and end.
“Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension,” the authors wrote. “This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care.”
Crowley MJ, Melnyk SD, Ostroff JL, Fredrickson SK, Jeffreys AS, Coffman CJ, Edelman D. Can group medical clinics improve lipid management in diabetes? Am J Med
. 2014 Feb;127(2):145-51. doi: 10.1016/j.amjmed.2013.09.027. Epub 2013 Oct 15.
PubMed PMID: 24462012.
ATLANTA — About 5% of the United States population has been diagnosed with type 1 diabetes, and the great majority are diagnosed before age 25. Since a diabetes diagnosis prevents enlistment in the military, relatively few veterans have the condition compared to type 2 diabetes, which affects about a fourth of VHA patients.
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