Re: Evaluation of an Ongoing Diabetes Group Medical Visit in a Family Medicine Practice

To the Editor: We want to share our experience with a similar patient demographic using diabetes shared medical appointments (SMAs). The report, by Cunningham et al.¹, describes a series of four 2-hour sessions. One hour is dedicated to a traditional one-on-one medical appointment with additional time for goal setting, while hour two is group diabetes self-management education. These are two different components, not an SMA.

The traditional one-on-one medical visit does not work for the care of chronic medical conditions, as exemplified by the low number of people with diabetes meeting goals for HbA1c, blood pressure, and lipids. Our group has previously described a multidisciplinary SMA model that incorporates medical care (directed by an endocrinologist), patient support, and interactive group education with improved access to care and lower HbA1c levels.² The value of an SMA lies in patient education, empowerment, and engagement. The tagline for every SMA should be, “What happens in the group is good for everyone in the group.” Over time, patients build relationships with staff and other patients that would be challenging to develop in a limited number of sessions.

We appreciate the work our colleagues across the Delaware River have done to improve the care of patients with diabetes. We would encourage them to continue their work while changing the model to promote more sharing of patient experiences.

We call for changes on a national level to develop SMA best practices to aid in further evaluation of this innovative care model, develop a national working group to share SMA models and experiences across disease states, and for medical associations to designate time at national conferences to new models of care delivery.