Patients are part of the team in diabetes management

Patient registries and group visits are "on the verge of becoming part of the standard of care" in diabetes management, said Edward Shahady, MD, Clinical Professor of Family Medicine, Florida State University, Tallahassee.

"The routine office visit does not work: only 7% of patients with diabetes meet all 3 goals for HbA1c, LDL-cholesterol, and BP. Patient registries and group visits can help us achieve goals needed for successfully managing diabetes," he said.

Patient registries are databases that can be either Internet- or personal computer-based. The registry contains the patient's weight, height, body mass index, eye and foot examinations, and HbA1c levels. Reports can be printed for the patient and physician.

For the patient, the reports have plain-English interpretations of medical markers; for instance, LDL-cholesterol is subtitled "bad cholesterol." The reports also indicate when to take medications and how much.

The registries chart individual patient success or failure and help a physician prioritize care. The database also allows payers to follow the performance of the medical practice.

Group visits bring together 8 to 10 patients for 3 visits over a 6 to 8 week period. Successful patients graduate, and those who fail are asked to repeat the cycle. The visits are 2 hours long, with a nurse or medical assistant facilitating 1 hour and the physician the other hour. Peer counseling and self-empowerment consistently occur in the group visit setting, said Dr Shahady. "As a doctor, you can only push a patient so much. We doctors also don't have to have all of the answers. Patients have plenty of answers," he said.