Piatt and colleagues sought to determine if improvements observed in clinical, behavioral, and psychosocial outcomes measured at 12 months following a multifaceted diabetes care intervention were sustained at 3-year follow-up. The study was a multilevel, nonblinded, cluster design, randomized controlled trial that took place in an underserved suburb of Pittsburgh, Pennsylvania, between 1999 and 2005. Eleven primary care practices and their patients were randomly assigned to three groups: (a) chronic care model (CCM) intervention (n = 30), (b) provider education only (PROV) (n = 38), and (c) usual care (UC) (n = 51). Subjects were followed for three years. Improvements observed at 12-month follow-up in glycemic (-0.5%) and blood pressure control (-4.8 mm Hg), and the proportion of participants who self-monitor their blood glucose (86.7%-100%), were sustained at three-year follow-up in the CCM group. Additional improvements occurred in non-HDLc levels in all study groups and quality of well-being scores in the CCM intervention group. All associations remained after controlling for medication treatment intensification.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The investigators demonstrated that improvements in outcomes could be sustained over time following a multifaceted diabetes care intervention. Future research in this area is necessary to understand if improvements in outcomes can be sustained following diabetes self-management education (DSME) and what type of patient fares the best from multifaceted diabetes care interventions.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: If you have diabetes, it is imperative that you participate in a self-management program. As shown in the study, the effects can be enduring if you continue to perform the skills you are taught in self-management. The investigators should be applauded for obtaining long-term data in support of self-management.

GA Piatt et al. 3-Year Follow-up of Clinical and Behavioral Improvements Following a Multifaceted Diabetes Care Intervention: Results of a Randomized Controlled Trial. Diabetes Education, March 3, 2010.