Abstract

Outcomes of a multidisciplinary team approach to cardiovascular risk reduction in patients with diabetes mellitus

Author(s): Angela M Taylor, Coleen A McNamara, Anne Hedelt, Cherie Chaney, Mary Lou Perry, Thomas M Miller III, Karen D Tyler and Anthony L McCall

Introduction: Cardiovascular risk reduction can decrease morbidity and mortality in patients with diabetes mellitus; however, it is seldom optimally achieved with standard care. Methods: We herein report on the rationale and preliminary results of a clinic model using a multidisciplinary team approach to improve cardiovascular risk management in patients with diabetes mellitus. We assessed risk-factor management for glycemia, dyslipidemia, hypertension and lifestyle in a retrospective survey of patients followed for 1 year or longer, in comparison with cardiology practice patients in a separate clinic at the same institution. Results: We demonstrated that intervention by a team including a cardiologist, endocrinologist, certified diabetes educator, dietician, cardiovascular advanced practice nurses and an exercise physiologist resulted in a high percentage of patients at National Cholesterol Education Program goals for secondary prevention of coronary artery disease compared with standard care. A comparison was made with 40 patients in each group with a mean age of 62 years with approximately 50% of those women with an average A1c of 8%. The multidisciplinary approach resulted in a significant decrease in A1c (p = 0.004) and triglycerides (p = 0.002) compared with standard therapy. There was a trend toward a significant increase in high-density lipoprotein (p = 0.07). There were no differences in total cholesterol, low-density lipoprotein, or blood pressure between the two groups. Conclusion: Multidisciplinary team care improves risk-factor modification primarily by improving glycemia and dyslipidemia. This model may be useful for enhancing the multiple risk-factor modifications needed to reduce cardiovascular morbidity in patients with diabetes mellitus and the metabolic syndrome.