Introduction and Objective: Nearly half of US adults with type 2 diabetes (T2D) 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. This study examined the association between three key components of a chronic condition population management program and A1c target achievement within a large integrated health system, stratified by race/ethnicity.Methods: This retrospective nested case-control study utilized Kaiser Permanente Southern California data (2017-2022). Patients (18-75 years) with T2D and baseline A1c≥7% were included. Cases (two consecutive A1c<7%) were matched to controls (1:3 ratio) based on baseline A1c (±0.2%) and follow-up duration. The exposure variable was predominant encounter type, categorized into three levels: 1) Primary Care Physician (PCP), 2) Population-Care Management (PCM), and 3) Diabetes Self-Management Education and Support (DSMES). Conditional logistic regression assessed the independent effects of predominant encounter type on A1c, adjusting for covariates.Results: The sample included 317,284 patients (94,647 cases) with a median age of 59 years. The sample was 49% Hispanic, 24% White, 13% Asian, 9% Black, and 1% Native Alaskan/Pacific Islander. Median follow-up was 11 months. Patients with DSMES as their predominant care had significantly 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/ethnic groups.Conclusion: DSMES was associated with the most robust effect on A1c target achievement. Further resources devoted to enhancing DSMES reach and effectiveness have the potential to help more patients living with T2D achieve sustained glycemic control and prevent complications in T2D.
T. Formagini: None. M. Kim: None. X. Wei: None. S. Tovar: None. A. Salvador: None. R.R. Nanda: None. T. Hsieh: None. J.P. Martin: None. K.J. Coleman: None. B.U. Wu: None.
Regional Research Committee of Kaiser Permanente Southern California (KP-RRC-20230403)
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