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INTRODUCTION
Diabetes is a major health problem in the United States and drives a large portion of yearly healthcare expenditures. More than 8% of the population suffers from the disease, or 25.8 million people, 7 million of whom are undiagnosed. Complications of diabetes include heart disease, stroke, kidney disease, blindness, and neuropathy. The United States spent $245 billion on diabetes in 2012, including $176 billion in direct medical costs alone—a 40% increase since 2007. 1
Self-management education is an essential element for combating diabetes and its complications, as well as for improving patients' quality of life. 2 Multidisciplinary teams led by a diabetes educator and typically including a registered nurse, registered dietician, and a pharmacist have demonstrated the best results. 3 However, the availability of the requisite practitioners and time present major barriers to success.
To address these obstacles, the Ochsner Internal Medicine Clinic developed a Diabetes Boot Camp as an alternative to the more comprehensive, multivisit American Diabetes Association (ADA)-certified education program offered by the Ochsner Diabetes Institute. The boot camp is a single 2-hour session during which patients spend 30 minutes each with a nurse practitioner or physician, a pharmacist, a nurse educator, and a dietician. Short-term results after a mean of 6 months, comparing patients who attended the boot camp with those who received standard care in the clinic, demonstrated a significant improvement in glycemic control. 4 This study is a follow-up of the same patients to evaluate long-term efficacy of the Diabetes Boot Camp.
METHODS
This retrospective cohort study compared the effects of the Diabetes Boot Camp with the standard of care in an internal medicine practice on various measures of diabetic control. The Ochsner Institutional Review Board reviewed and approved the study (IRB #2010.163.B). The study was performed at Ochsner Medical Center, New Orleans, LA, in the internal medicine outpatient clinic. A full description of the research design and methods has been previously described. 4
The 3 study questions to be answered were
* 1. In the group of patients with HgA1c ≥9%, was there a greater decrease in HgA1c among the patients receiving care in the Diabetes Boot Camp compared with those receiving the standard of care?
* 2. In the group of patients with HgA1c <9%, was there...