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California Medi-Cal Type 2 Diabetes Project
Contributed By: California Diabetes Program
Author: Gary He, PhD
The MediCal Type 2 Diabetes Project assessed the impact of enhanced primary care plus case management on glycemic control and risk factors in MediCal recipients aged 18 yrs or older with type 2 diabetes. This project was a collaboration between by Harbor UCLA Medical Center, University of California, San Diego, Sansum Medical Research Institute, and the California Diabetes Program.
Article Abstract
OBJECTIVE—Disparities exist in the diabetes health status of ethnic minority and/or low-income populations relative to other groups. A primary objective of diabetes management is to improve glycemic control. The feasibility of implementing intensive diabetes case management in disparate populations remains largely untested.
RESEARCH DESIGN AND METHODS—Clinical sites in three southern California counties serving low-income, ethnic minority populations participated in our study. We randomized 362 Medicaid (called Medi-Cal in California) recipients with type 2 diabetes for at least 1 year to intervention (diabetes case management) or control (traditional primary care treatment) groups. Fifty-five percent of participants were minorities. Participants with HbA1c levels less than 7.5%, serious diabetes-related complications, or other serious medical conditions were excluded. We assessed the effect of the intervention (ongoing diabetes case management added to primary care) on glycemic control using serial HbA1c measurements over several years.
RESULTS—The mean duration of follow-up was 25.3 months. HbA1c decreased substantially in both groups from an average of 9.54–7.66% (a reduction of 1.88%) in the intervention group and from an average of 9.66–8.53% (a reduction of 1.13%) in the control group. This improvement was sustained throughout the study. The reduction in HbA1c was consistently greater in the intervention group at each time point (P < 0.001), ranging between 0.65 at 6 months and 0.87 at study end.
CONCLUSIONS—Diabetes case management, added to primary care, substantially improved glycemic control compared with the control group. Diabetes case management can help reduce disparities in diabetes health status among low-income ethnic populations.
Reference: The California Medi-Cal Type 2 Diabetes Study Group. Closing the Gap: Effect of Diabetes Case Management on Glycemic Control Among Low-Income Ethnic Minority Populations. The California Medi-Cal Type 2 Diabetes Study. Diabetes Care 27:95-103, 2004
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Baseline demographics, HbA1c, socioeconomic factors, ethnicity, and diabetes-related complications were similar in both groups. Mean duration of follow-up for patients included in analyses was 25.3 months. HbA1c decreased in both groups: 9.54% to 7.66% (Intervention), 9.66% to 8.53% (Conventional). In Intervention group: 1) HbA1c reduction was greater than in Conventional by 0.65% units at each time point (p < 0.0011); 2) use of diabetes medications increased (p = 0.01); and 3) LDL cholesterol decreased (p = 0.02).
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