The most significant effect observed is with the change from baseline results .
Some evidence suggests post-intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe .
There is no evidence that group visits improve LDL cholesterol values of the group visit participants .
IMPLICATION S FOR PRACTICE The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs .
BACKGROUND The prevalence of diabetes mellitus is ubiquitous .
Complications and costs of diabetes are rising and are depleting limited re sources .
It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions .
An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit .
Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting .
A study of central serotoninergic activity in healthy subjects and patients with Type 2 diabetes treated by traditional one-to-one care or Group Care.
AIM Central serotoninergic activity may modulate glucose metabolism via neuroendocrine effectors . Group Care is a clinico-pedagogic intervention that improves metabolic control and quality of life in Type 2 diabetes through lifestyle modification and , possibly , central mechanisms . The hypothesis that central serotoninergic activity is modified in patients followed by Group Care  was tested by measuring their hypothalamic- pituitary-adrenal response to citalopram , a selective serotonin reuptake inhibitor . METHODS AND SUBJECTS Ten healthy controls and 17 non-obese , non-insulin-treated patients with Type 2 diabetes received , in r and om order , iv infusions of either 20 mg citalopram or saline .  Nine patients had been longterm on Group Care and 8 had always been on traditional one-to-one  care . Circulating glucose , insulin , ACTH , cortisol , DHEA , GH and PRL were measured every 15 min for 240 min . Differences between areas under the curves after citalopram and saline ( Δ-AUC ) were calculated . RESULTS Citalopram stimulated ACTH and cortisol secretion in healthy subjects ( p=0.026 and p=0.011 , respectively ) and patients on Group Care ( p=0.056 and p=0.038 ) but not in patients on traditional care . In healthy subjects , basal glucose correlated with growth hormone Δ- AUC ( r=0.820 ; p=0.004 ) and inversely with insulin Δ-AUC ( r=-0.822 ; p=0.003 ) . The former correlation was preserved in the patients ( r=0.637 ; p=0.026 ) . CONCLUSIONS Diabetes may blunt the response of the hypothalamic-pituitary-adrenal axis to citalopram , but this is preserved in patients followed by a long-term intervention model that improves clinical as well as cognitive and emotional variables
The most significant effect observed is with the change from baseline results .
Some evidence suggests post-intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe .
There is no evidence that group visits improve LDL cholesterol values of the group visit participants .
IMPLICATION S FOR PRACTICE The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs .
BACKGROUND The prevalence of diabetes mellitus is ubiquitous .
Complications and costs of diabetes are rising and are depleting limited re sources .
It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions .
An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit .
Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting .