Implementing an osteoarthritis management program to deliver guideline-driven care for knee and hip osteoarthritis in a U.S. academic health system

Objective

Assess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center.

Design

This open study assessed an OAMP designed to deliver care in 1-5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017-1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability.

Results

Most patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4-3.9 on 0-10 scale, p ​= ​0.002). BMI did not significantly change (p ​= ​0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4-24 ​h weekly) and serving 953 patients over four years demonstrated OAMP sustainability.

Conclusions

OAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.

Feasibility Study of a Low-Carbohydrate/Time-Restricted Eating Protocol for Insulin-Using Type 2 Diabetic Patients

INTRODUCTION

Low-carbohydrate diets and time-restricted eating are methods to improve hemoglobin A1C in patients with type 2 diabetes. However, insulin-using patients are often counseled against these practices due to hypoglycemia concerns. This observational study evaluated a protocol utilizing both methods coupled with proactive insulin titration.

OBJECTIVES

To evaluate the safety and feasibility of a timed eating protocol for insulin-using patients and to assess its impact on outcomes, including insulin use and hemoglobin A1C.

METHODS

Participants included insulin-using adults ages 49 to 77 years with type 2 diabetes. They were counseled to eat 2 meals per day in a 6- to 8-hour window of their choosing, with a goal intake of ≤ 30 grams of carbohydrates per day. Glucose was closely monitored, and insulin was adjusted per study protocol. Primary outcomes included hypoglycemic events and compliance with timed eating. Insulin use, hemoglobin A1C, body mass index, blood pressure, and quality of life also were measured.

RESULTS

Nineteen of the 20 participants completed the 6-month study. No hypoglycemic events requiring urgent medical care occurred. Symptomatic episodes with glucose between 47 and 80 mg/dl were reported by 37% (7/19) of participants. Average daily insulin use decreased by 62.2 U (P <  0.001) and insulin was discontinued for 14 participants. Average hemoglobin A1C remained unchanged. Average body mass index decreased by 4.0 (P = 0.01), systolic blood pressure decreased by 9.9 mm Hg (P = 0.02), and diabetes-related quality-of-life metrics improved significantly.

CONCLUSIONS

These results demonstrate that a time-restricted eating protocol is feasible and safe for insulin-using patients with type 2 diabetes when paired with a proactive insulin titration.

Multimodal Care for Knee and Hip Osteoarthritis: A Pilot Feasibility Study of a Novel Approach to a Common Problem

BACKGROUND

Osteoarthritis is common and debilitating. Evidence-based care exists; there is a gap between recommended and received are. Multimodal treatment is recommended, with unknown effectiveness. We report pilot feasibility data for a new university-based clinic providing multimodal care for knee and hip osteoarthritis (KHOA).

METHODS

Quality-improvement case series with the first 50 patients. A multidisciplinary team provided care. Feasibility outcomes included treatment duration, patient adherence, provision of guideline-recommended care, and satisfaction. Secondary outcomes included self-reported and objectively assessed patient measures.

RESULTS

Fifty patients (59±10.5 years, 32 female) received guideline-recommended care; 40 adhered to 3.83±2.21 follow-up visits over 12.24±7.79 months; satisfaction was high. Objectively assessed outcomes improved, but self-reported outcomes did not.

DISCUSSION

Early data suggest multimodal care for knee and hip osteoarthritis is feasible and may be associated with improved outcomes.