Lowering A1c Through Integrated Behavioral Health Group Visits.

Introduction & Objective: Suboptimal adherence to medication and lifestyle modification continues to be a problem in diabetic patients in the US. Previous studies have investigated the potential of group educational visits in improving medication adherence and short-term health outcomes, but few have done so using a biopsychosocial approach in visits. This study aimed to evaluate the effect that group visits, conducted using an integrated behavioral health model at a primary care practice, had on A1c and distress levels in diabetic adults.

Methods: Using the Diabetic Distress Scale (DDS), 15 adults were identified as having moderate diabetic distress (> 3.0) between December 2016 and May 2017 and invited to attend a group visit in May 2017 to address identified barriers. Of those, nine attended. The group visit, conducted by a psychologist, sought to reduce diabetic distress by targeting behavioral and social factors, including improving social and familial support, using diabetes online forums, and improving mind-body connection. Repeat A1c and DDS measurements for all nine visit participants were collected three months after.

Results: Group visit participants experienced a decrease in A1c (p=0.011). All nine participants had a decrease in their post-intervention DDS. Of the six patients who had positive DDS screens but did not attend, three had increased A1c, two had no change, one had a decrease, and one did not have a repeat A1c.

Conclusions: Multidisciplinary group visits targeting the biopsychosocial model may be an efficient supplement to the individual medical visit to further improve control of diabetic distress and short-term morbidity in Rhode Island.