Innovating Diabetes Care in Pregnancy: Do Group Care Models Improve Outcomes and Equity? A Report on Research Supported by Pathway to Stop Diabetes.

Abstract

Shared medical appointments (SMAs) for diabetes and group prenatal care (GPC) for pregnant patients have emerged as innovative care delivery models. They have the potential to transform diabetes care by overcoming many of the time limitations of traditional one-on-one clinical visits. There is compelling evidence that SMAs improve glycemic control for nonpregnant patients with diabetes, GPC reduces Black and White health disparities in preterm birth, and diabetes GPC increases postpartum glucose tolerance test uptake among patients with gestational diabetes mellitus. GPC models stand out as one of few interventions that reduce racial health disparities, which we hypothesize occurs because their effect is inadvertently exerted on both the patient and clinician through an over 20-h meaningful shared experience. In this article I explore the evidence for SMAs and GPC in diabetes and pregnancy, theoretical underpinnings of the models, their potential to promote more equitable care, and future directions from my perspective as a physician in high-risk obstetrics and 2019 American Diabetes Association Pathway Accelerator Award recipient. This article is part of a series of perspectives that report on research funded by the American Diabetes Association Pathway to Stop Diabetes program.