Graduation Date

Summer 8-9-2019

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Corrine Hanson, PhD

Second Advisor

Elizabeth Lyden

Third Advisor

Ann Anderson-Berry

Fourth Advisor

Glenda Woscyna

Abstract

OBJECTIVE: The objective of this paper is to investigate the effectiveness of diabetes education provided by registered dietitians (RD) in a diabetes case management (DCMs) model, compared to diabetes education provided by RDs in the usual care model (UCM) at an outpatient endocrinology clinic in Omaha, Nebraska. This study hypothesizes that education by RD DCMs will be equal or more efficacious in regards to primary outcomes of A1C and BMI and secondarily, lipid results and adherence (total encounters) when compared to outcomes of UC.

METHODS: This is a cross sectional retrospective review of patients with diabetes (n=946), receiving traditional RD education (n=445) and DCM (n=501). Groups had like distribution of A1C and lipids at baseline. The DCM group had a higher BMI, higher percentage of male subjects and older population compared to the UCM at baseline. BMI, Lipids, A1C and total encounters were compared from initial visit to 12 months. SPSS software provided descriptive statistics of the sample groups and independent samples t-test for differences of means between groups. P-value of < 0.5 was considered statistically significant.

RESULTS: Primary outcomes were endpoint A1C and BMI and mean change in A1C and BMI at 1 year. Endpoint A1C was lower in the DCM (8.0 vs. 8.4, p= 0.02). Mean A1C change was -0.4 in DCM, compared with - 0.2 in UCM (p=0.06). Endpoint BMI was higher in the DCM (32.7 vs 31.5, p=0.04), however BMI declined slightly (- 0.04) in DCM and increased slightly (+ 0.2) in the UCM (p=0.07). Secondary findings included greater mean change in LDL in DCM (+1.78 vs - 4.16, p=0.002) and higher number of overall encounters with RD (10.01 vs 7.39) and Endocrinogist (11.11 vs 8.22) (p=0.001) in DCM group. No significant differences were found in HDL or Triglycerides.

CONCLUSION: The DCM group had improvements in endpoint and change in A1C and change in LDL. Of note, the DCM group results for mean change in BMI showed a trend toward significance. DCM subjects attended more visits with the RD and Endcrinologist, suggesting more engagement in the DCM than the UCM. Further research should analyze interventions within the DCM model, compared to the UCM. Additional study is needed regarding cardiovascular risk benefit over time and cost-benefits of the model.

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