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In people with diabetes, group medical visits reduce HbA1c levels more than usual care

Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ. 2013;185:E635-44.

Review question

In people with type 1 or type 2 diabetes, do group medical visits improve patient outcomes more than usual care?

Background

People with diabetes are at higher risk than many other people to get cardiovascular disease (for example, heart attack or stroke).

Family doctors can help people with diabetes manage their cardiovascular risk factors, such as blood glucose levels, blood pressure, weight, body mass index, and cholesterol levels.

Most people meet with their family doctors one-on-one. In group medical visits, several people with the same disease meet with their doctor or nurse at the same time. Other health care workers, such as pharmacists or nutritionists, may also be at these visits.

How the review was done

The researchers did a systematic review, searching for studies that were published up to February 2012.

They found 13 randomized controlled trials with 2319 people and 13 nonrandomized trials with 3498 people. The key features of the randomized controlled trials were:

  • People had type 1 or type 2 diabetes and were 16 to 80 years old.
  • At group visits, people could get a health evaluation, information about their disease, prescriptions or referrals, or be sent for lab tests; they could also talk with other people with diabetes.
  • Group medical visits were compared with usual care.
  • The outcomes were glycated hemoglobin (HbA1c) levels, cardiovascular risk factors, and quality of life; they were measured at 4 months to 5 years after group visits started.

What the researchers found

These are the findings from the randomized controlled trials, which usually have higher quality results than nonrandomized trials.

Compared with usual care, group medical visits

  • reduced HbA1c levels by an average of 0.46%, although the difference could be as little as 0.12% or as much as 0.80%. So if a person started out with a glucose level of 8.5%, on average that would drop to about 8%.
  • were no better for reducing cardiovascular risk factors.
  • did not improve quality of life.

Conclusion

In people with type 1 or type 2 diabetes, group medical visits reduce HbA1c levels more than usual care. They do not reduce cardiovascular risk factors or quality of life.

Group medical visits vs usual care

Outcome

Average difference at follow-up

Range of effect

HbA1c

0.46% less with group medical visits

As little as 0.12% to as much as 0.80% difference

 

View Clinician article

Related Topics

Glossary

Body mass index
Indicates whether someone’s height and weight puts them at an increased risk of a number of chronic diseases.
Cholesterol
A fat-like substance with a soft, waxy texture.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

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