The Impact of Integrated Behavioral Health in a Diabetes Center

Integrated behavioral healthcare (IBH) is recommended as the gold standard to address psychosocial factors in diabetes management. While it is well documented that psychosocial interventions improve outcomes, there is a dearth of literature on the benefits of integrating behavioral health providers (BHP) into standard diabetes care. IBH involves collaborating with physicians, nurses, educators, and dieticians to formulate comprehensive treatment plans, and has the potential to have a substantial impact on diabetes management beyond any standalone intervention. The purpose of this study was to examine the impact of IBH on HbA1c levels in patients seen by BHPs. Data were drawn from electronic medical records and included demographic characteristics, dates of each IBH encounter, and A1c’s beginning one year before first BHP visit through one year post initial visit. Patients with a baseline A1c over 8% who had at least one visit with a BHP in a diabetes clinic at a large academic medical center were included (n = 374). Piecewise mixed effects growth mixture models were run to assess whether A1c slope was different between two time periods: pre-initial BHP visit and post-initial BHP visit. Random intercepts and random slopes were used to best model the variability in encounter frequencies among patients. The overall model was significant (Wald χ2 = 48.19, p<0.001). The slope for the period before initial BHP visit was not significant (p=0.28), indicating no evidence of linear decrease or increase in A1c values. The slope for the period after initial BHP visit was significant (p<0.001) and negative (z=-6.45), indicating that A1c values showed a significant, linear decrease over the first year after an initial BHP visit. These results provide early evidence that BHP encounters are associated with statistically significant reductions in A1c values in the year after first encounter, illustrating the benefit of IBH in diabetes care. Disclosure K.L. MacGregor: None. K.S. DeMartini: None. S.A. Barry: None. A.G. Derr: None. M.J. Thompson: None.