Do group visits improve HbA1c more than individual visits in patients with T2DM?
EVIDENCE-BASED ANSWER:
Yes. In patients with type 2 diabetes mellitus (T2DM), group visits led by health professionals or teams improved glycosylated hemoglobin (HbA1c) by 0.3% to 0.9% over usual care (strength of recommendation [SOR]: B, meta-analyses of randomized clinical trials [RCTs] with moderate to high risk of bias).
Patients taking oral antidiabetic agents alone appear to benefit more than patients on insulin. Peer-led group visits likely have no effect (SOR: B, subgroup analysis within a meta-analysis).
Treatment durations as long as 3 years are associated with larger decreases in HbA1c (by 0.25% per year) than treatment lasting less than a year (SOR: B, meta-analysis of RCTs involving patents with type 1 diabetes and T2DM).
Patients with T2DM should be offered group visits for diabetes education when available (SOR: C, expert opinion).
RECOMMENDATIONS
The 2015 National Institute for Health and Care Excellence guideline for the management of T2DM in adults calls group education programs “the preferred option” for diabetes education, suggesting that clinicians reserve individual education for patients unable or unwilling to participate in group programs.4
The 2017 diabetes self-management education and support policy endorsed by the American Diabetes Association recommends using interprofessional teams and “creative solutions” to increase patient engagement and endorses group meetings as an effective option for patients who choose them.5
Editor’s takeaway
Moderate-quality evidence demonstrates that group visits can significantly reduce HbA1c levels. We should consider them for our patients with diabetes who are willing to attend group sessions.
