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Educational Intervention Fails to Improve Type 2 Diabetes Guideline Adherence

September 08, 2016

Recent research in the Journal of Managed Care and Specialty Pharmacy showed that an educational intervention aimed at improving physician and patient adherence to type 2 diabetes guidelines, failed to affect the frequency of A1c testing or in the initiation of insulin in patients with type 2 diabetes. The researchers suggested that these findings are concerning due to the significant investment that managed care organizations make in these types of programs.

A major concern facing patients with diabetes is clinical inertia, meaning recognition of a problem with a patient’s management but failing to act.

“Despite managed care organizations making significant investment in this area, little is known about the impact of educational programs aimed at aligning patients and their physicians with diabetes guidelines and thus overcoming clinical inertia,” Nella Bieszk, PharmD, director of National Medical Management at Sanofi US, and colleagues wrote.

In order to assess the impact of an educational intervention specifically designed to align patients and their physicians with 2012 American Diabetes Association guidelines on A1c testing frequency and insulin initiation, researchers developed the “Act on Threes” program.

Act on Threes, a 12-month, randomized controlled prospective study that included 6243 Medicare Advantage patients aged 18 to 85 with type 2 diabetes. Eligible patients received 3 or more oral antidiabetic drugs (OADs), had A1c not at goal, and had no recent A1c evaluation over 12 months, as identified through the analysis of administrative claims data from the Humana database.


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A total of 4555 patients were randomized into the educational intervention group combined with standard care group and 1688 patients were randomized into the standard care alone group. Researchers used descriptive statistics to analyze the differences between the intervention and control groups. Additionally, multiple logistic regression analysis was used to identify determinants of insulin initiation in the full study cohort.

Study results showed that patients with 2 or more A1c tests per year was not significantly different post intervention for patients in both the intervention and control groups (47.7% vs. 46.8%, respectively; = .995). Both groups experienced an increase in frequency of A1c testing from pre- to post-intervention; changes in A1c levels was also similar for both groups (P = .240). Researchers also concluded that a similar amount of patients in the intervention and control group initiated insulin during the post intervention period (6.3% vs. 7.6%, respectively; P = .059).

“These findings are in contrast to uncontrolled comparative studies showing significant improvements in outcomes post intervention and reinforce the importance of study design in evaluating the effectiveness of educational programs,” Bieszk and colleagues concluded.

The study was funded by Sanofi US. ---Julie Gould




Bieszk N, Wei W, Reynolds SL, et al. “Act on Threes” Paradigm for Treatment Intensification of Type 2 Diabetes in Managed Care: Results of a Randomized Controlled Study with an Educational Intervention Targeting Improved Glycemic Control [published online September 2016]. J Manag Care Spec Pharm. 2016 Sep;22(9):1028-1038. DOI:


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