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Diabetes Coaching Program is Helping Struggling Patients Improve Dangerously High Blood Sugars

Date Posted: Friday, April 22, 2022


A diabetes diagnosis is life changing. For many patients, implementing new medications and exercise & healthy eating plans is overwhelming. For some, dealing with the mental health implications of a future with diabetes can hinder being successful.

The American Diabetes Association-recognized diabetes education program at the UMass Memorial Health Diabetes Center of Excellence (DCOE) covers a wide variety of topics including nutrition, insulin pumps & continuous glucose monitors, preventing complications, physical activity and more. 

Diabetes education has been shown to lower A1c and blood glucose similar to medication but without side effects. Many research studies have shown that people who receive diabetes education are more likely to utilize primary care and preventative services, take medications as prescribed, and control their blood glucose, blood pressure and cholesterol levels. As a result, those people reportedly have lower health costs.

Despite receiving diabetes education, some people still struggle to keep their blood glucose within a healthy range. The DCOE piloted a Care Coach Program to provide supplemental support to help them manage blood glucose levels. Participants have successfully lowered their A1c and demonstrated a reduction in the distress caused by their diabetes by implementing behavioral, lifestyle, and medication changes, thanks to more frequent contact with a diabetes expert. Funding for this initiative was generously provided, in part, by the George F. and Sybil H. Fuller Foundation.

The Problem

Despite receiving diabetes education, some patients continue to have a sustained A1c above 9.0%, and some high-risk individuals face consistent challenges managing diabetes on their own. Many of these patients have missed appointments with their diabetes care team and/or stopped making future appointments.  

The Solution

The Care Coach Program was developed in collaboration with Shields Health Care Group. Patients receive frequent touchpoints with a personal diabetes coach to administer the care plan developed by their endocrinologist and/or nurse practitioner.  

Coaches engage with patients frequently and serve as the go-to resource for all of their diabetes needs, including:

  • Managing medications (e.g., medication changes, financial assistance, refills)
  • Managing blood sugar (e.g., individual trends, approaches to keep in target range)
  • Training on diabetes technology (e.g., continuous glucose monitoring)
  • Encouraging better lifestyle habits (e.g., motivation, exercise, and nutrition plans)

The Results

Patients experienced an average drop in their A1c of greater than 2.2% consistently at their six, nine and twelve month visits. The data shows total hospitalizations were reduced for the participants and diabetes related hospitalizations and ER visits were reduced following participation ion the program. This success was a result of better adherence to medications (95% vs. almost zero), direct contact and frequent touchpoints with coaches, and successful lifestyle changes. There was also a reduction in diabetes related distress as measured by the Problem Areas in Diabetes questionnaire score. Preliminary data may suggest a decrease in hospitalizations.

Success Story: Michael O'Rourke 

Michael was diagnosed with type 2 diabetes in his 20’s but for more than 40 years has admittedly done little to proactively manage it until enrolling in the Care Coach Program at the UMass Memorial Diabetes Center of Excellence. During his first six months working with a diabetes coach, his A1c dropped from 8.5% to 7.8%. He credits his new continuous glucose monitor & weekly coaching calls with keeping him on track. Learn More

The Care Coach Program, piloted by endocrinologists Richard Haas, MD, and Vrushali Shah, MD, is now be implemented across the UMass Memorial DCOE.

Vrushali Shah, MD                                   Richard Haas, MD

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