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Exploring Methods to Extend the Reach of Diabetes Specialist Expertise Into Primary Care Clinics

From the Diabetes Care Center, Salinas, California (Dr King, Mr Wolfe, Ms Healy, Ms Lineham, Ms Armstrong). Drs Harrison and Ponzio are primary care physicians in rural communities.

Correspondence to Allen King, MD, Diabetes Care Center, 1260 South Main Street, Suite 201, Salinas, CA 93901 (aking{at}diabetescarecenter.com).

The purpose of this article is to describe a pilot program using centralized diabetes specialist services to guide primary care treatment of diabetes. The program demonstrated the feasibility of disseminating diabetes treatment guidance from a centralized diabetologist clinic. Across all participating sites, approximately 50% of patients achieved HbA1c values of 6.9% or lower. Approximately 80% of all patients participating achieved low-density lipoprotein cholesterol values of 129 mg/dL or lower, and 50% had systolic blood pressure values of 129 mm Hg or lower. Results of the program are promising and deserve further study. Hallmarks of the program include dissemination of diabetes care through midlevel practitioners in primary care offices, using standardized algorithms, and computer-assisted guidance of therapy.

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