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Improving Glycemic Control Through Population-Based Strategies: A Case-Control Study Within a Large Health System.

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Τίτλος: Improving Glycemic Control Through Population-Based Strategies: A Case-Control Study Within a Large Health System.
Συγγραφείς: Formagini T; Department of Research & Evaluation, Division of Health Services Research and Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, USA. taynara.x.formagini@kp.org.; Care Improvement Research Team, Kaiser Permanente Southern California, Pasadena, CA, USA. taynara.x.formagini@kp.org., Kim M; Regional Medical Office Clinic Administration, Adult Primary Care & Urgent Care Service Line, Kaiser Permanente Southern California, Pasadena, CA, USA., Wei X; Department of Research & Evaluation, Division of Clinician Research, Kaiser Permanente Southern California, Pasadena, CA, USA., Tovar S; Department of Research & Evaluation, Division of Clinician Research, Kaiser Permanente Southern California, Pasadena, CA, USA., Salvador AMG; Regional Center for Healthy Living, Kaiser Permanente Southern California, Pasadena, CA, USA., Nanda R; Regional Center for Healthy Living, Kaiser Permanente Southern California, Pasadena, CA, USA., Hsieh T; Endocrinology Department, Kaiser West Los Angeles Medical Center, Los Altos, CA, USA.; Diabetes Complete Care, Kaiser Permanente Southern California, Los Angeles, CA, USA., Martin JP; Diabetes Complete Care, Kaiser Permanente Southern California, Los Angeles, CA, USA.; Health Equity and Care Quality, Los Angeles Medical Center, Los Angeles, CA, USA.; Southern California Permanente Medical Group, Pasadena, CA, USA., Coleman KJ; Department of Research & Evaluation, Division of Health Services Research and Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, USA.; Care Improvement Research Team, Kaiser Permanente Southern California, Pasadena, CA, USA., Wu BU; Care Improvement Research Team, Kaiser Permanente Southern California, Pasadena, CA, USA.; Department of Research & Evaluation, Division of Clinician Research, Kaiser Permanente Southern California, Pasadena, CA, USA.
Πηγή: Journal of general internal medicine [J Gen Intern Med] 2026 Oct; Vol. 41 (13), pp. 3719-3728. Date of Electronic Publication: 2026 May 01.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE
Imprint Name(s): Publication: Secaucus, NJ : Springer
Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986-
Ιατρικοί όροι (MeSH): Glycemic Control*/methods , Glycemic Control*/standards , Diabetes Mellitus, Type 2*/therapy , Diabetes Mellitus, Type 2*/blood , Diabetes Mellitus, Type 2*/epidemiology, Glycated Hemoglobin/metabolism ; Glycated Hemoglobin/analysis ; California/epidemiology ; Blood Glucose/metabolism ; Humans ; Retrospective Studies ; Case-Control Studies ; Middle Aged ; Female ; Male ; Aged
Περίληψη: Background: Nearly half of US adults with type 2 diabetes fail to achieve glycemic control (A1c < 7%), increasing complication risks. The American Diabetes Association recommends system-level strategies to optimize care delivery, yet the real-world impact of population-based programs on A1c control remains unclear.
Objective: To examine the association between three components of a diabetes management program and attainment of target A1c in patients with type 2 diabetes, as well as the relationship between encounter frequency and target A1c.
Design: This retrospective nested case-control study utilized data from Kaiser Permanente Southern California (2017-2022).
Participants: Patients with type 2 diabetes and baseline A1c ≥ 7%. Cases (two consecutive A1c < 7% within 2 years) were matched to controls based on baseline A1c and follow-up duration.
Main Measures: The primary exposure variable was predominant encounter type: (1) primary care physician (PCP), (2) population care management (PCM), and (3) Diabetes Self-Management Education and Support (DSMES). The secondary exposure variable was encounter frequency. Conditional logistic regression assessed the independent effects of predominant encounter type on A1c, adjusting for covariates.
Key Results: The sample consisted of 317,284 patients (94,647 cases), with a median age of 59 years, and 49% Hispanic. Patients with DSMES as their predominant care had higher odds of achieving A1c target (OR 1.39, 95%CI 1.35, 1.42), while those with predominantly PCM encounters had lower odds of achieving A1c target (OR 0.78, 95%CI 0.77, 0.80), compared to PCP-led care. Findings were consistent across racial and ethnic minority groups. The odds of achieving A1c control increased with encounter frequency up to 9-14 visits but diminished beyond this threshold, particularly at 25+ encounters.
Conclusions: Further resources devoted to enhancing the reach and effectiveness of DSMES may help more patients living with diabetes achieve sustained glycemic control and prevent complications.
(© 2026. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Competing Interests: Declarations. Human Ethics and Consent to Participate: This study was approved by the Kaiser Permanente Institutional Review Board [ID#13671]. The requirement for informed consent was waived due to the retrospective nature of the study and the use of de-identified electronic health record data, in accordance with applicable regulations and institutional policies. All data were handled in compliance with relevant data protection and privacy standards. Conflict of Interest: None to declare.
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Grant Information: KP-RRC-20230403 Kaiser Permanente
Contributed Indexing: Keywords: Type 2 diabetes; diabetes self-management education and support; glycemic control; population health management; real-world data
Substance Nomenclature: 0 (Glycated Hemoglobin)
0 (Blood Glucose)
Entry Date(s): Date Created: 20260501 Date Completed: 20261002 Latest Revision: 20261004
Update Code: 20261004
PubMed Central ID: PMC13631204
DOI: 10.1007/s11606-026-10383-w
PMID: 42067744
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1525-1497
DOI:10.1007/s11606-026-10383-w