Group Visits: Best Practices in Team-Based Care at MGH Back Bay

In April of this year, MGH Back Bay began trying out a new model for delivering care and education for their diabetes community: shared group medical visits. Led by a nurse practitioner, a diabetes nurse educator and a registered dietitian, these shared visits are offered to people with prediabetes or Type 2 Diabetes (newly diagnosed or anyone needing a little extra help bringing blood sugars under control). Visits are divided into two sessions, two weeks apart. The first session focuses on diabetes basics and nutrition; the second covers nutrition in more detail and reviews complications.

At the beginning of each session, the nurse practitioner meets with each participant for a short individual visit. A larger group discussion takes place afterwards. Although there is a curriculum with prepared material about A1C, blood pressure and cholesterol (LDL), the discussion is allowed to grow organically. Questions are encouraged and participants are welcome to share personal stories if they wish. Opportunities for hands-on learning are woven into the session, such as exercises on reading food labels or using rice in a shoe to illustrate symptoms of neuropathy. At the end of the second session, participants are asked to identify and write down one or two goals to work on. The diabetes nurse educator mails these goals two months after the group as a reminder of what was motivating them during the visit.

Response to the shared group visits has been very positive. The opportunity to talk about living with diabetes and learn tips from peers for overcoming every day challenges is a highlight for many. Much of the success of this visit model is the emphasis on team-based care. One of the reasons for offering shared visits was providing better access to nutrition education. Since a registered dietitian is there for the visit, participants do not need to schedule a separate appointment. The group setting also helps reduce anxiety some feel about seeing a dietitian. In addition to clinical outcomes (improved A1C, reduced weight), scheduling a follow up visit with a dietitian is considered a mark of success for this visit model.

More shared group medical visits have been planned for the fall. Given how well visits have gone so far, the practice is considering offering shared group visits for other chronic conditions such as hypertension

Fitness, Guest Post, My Story

Spotlight: Charlestown HealthCare Center Activity Tracker Pilot

By Rajani Larocca, MD
Charlestown HealthCare Center

with Chrisanne Sikora, Senior Project Specialist
Diabetes Self-Management Education Program

FitBit activity tracker

Lifestyle change is ultimately in the hands of the individual, and our job as medical  providers is to find a way to empower people to make those changes. It’s an old problem, but the question is: how do we get there? And can new technology help us solve the problem in new and innovative ways?

In spring 2013, I ran a series of six weekly group visits with a group of my patients at MGH Charlestown HealthCare Center. The group was originally intended for those with metabolic syndrome, but the majority of the patients already had Type 2 Diabetes.  The idea for this program came from an interest in applying a public health approach to medicine. All of the patients volunteered for the program on my recommendation. The focus of the visits was to educate the participants about healthy lifestyle change, to help motivate them to implement this change, and to provide a support system to help keep them motivated.

Each session focused on a different topic. In addition to the introduction in the first week and a summary group in the last week, we discussed nutrition, exercise, stress reduction, and social connection. A key part of the sessions included removing the all-or-nothing mentality that many people adopt when they are trying to be healthier, focusing instead on taking what steps you can and forgiving mistakes in the past.

During the meeting in which we discussed exercise, everyone who participated was given a FitBit activity tracker to wear. Once the trackers were on, the group went on a short walk through the neighborhood. Many were surprised to learn they didn’t have to walk far to reach 1,000 steps.

In subsequent sessions, reviewing the Fitbit data was part of what we did during our time together. Interestingly, everyone liked the Fitbits – even those who didn’t have ready internet access or who weren’t really internet-savvy. Because the trackers had a display which showed results in real time, everyone could tell whether they were reaching their goals on a daily basis. While there was some friendly competition among participants, most were only competing against themselves, trying to beat their totals from the previous week.

After the program ended, the participants were allowed to keep their FitBits, and some were still wearing them eight months later. Some of those who stopped wearing them said it was because they had incorporated their new habits into their routine and didn’t need the tracker anymore. When asked how he would keep up with his daily walks during the winter, one gentleman responded “I’ll wear a coat!”

Electronic trackers like the FitBit make developing healthy lifestyle habits more fun, but we can’t underestimate what the social connection of the group did to foster people’s success. The participants really enjoyed the group setting, especially the sense of community that developed and the confidence they gained from learning that others face many of the same challenges. Living with a chronic disease can be isolating, but in this group, people realized that they were not alone.


Healthy Holiday Cooking Chat

MGH logo with blue circle

Thanks to everyone who tuned in to our healthy holiday cooking chat earlier this week. Click below for highlights. Hope you’ll join us next month when we talk strategies for managing holiday stress with The Benson-Henry Institute for Mind Body Medicine.

Diabetes ABCs

Diabetes ABCs: Z

By Sandy O’Keefe
Program Manager, Chronic Disease Education


Zumba is a Latin-inspired dance fitness program featuring exotic rhythms set to high-energy Latin and international beats. Before participants know it, they’re getting fit and their energy levels are soaring!  It’s easy to do, effective and totally exhilarating, often building a deep-rooted community among returning students. Zumba is geared to people of all fitness levels. Dance moves are shown with modifications so students can workout at their current skill and ability level.  According to, over 14 million people of all shapes, sizes and ages take weekly Zumba fitness classes all over the world. Try a class today!


Join Us for Our First Twitter Chat!

Miss our chat?  No worries, you can read the transcript here.  Thanks to everyone who participated – we hope to do another one soon. 

MGH logo with blue circleWe will be hosting a nutrition Twitter Chat next
Thursday, October 18 from 12-1pm (EDT).
Katie Andrews, MS (Nutrition Communication) and Dietetic Intern here at Mass General will be leading the discussion and answering questions from the audience. 

Topics will include:

  • What tools can I use to choose better restaurant meals?
  • Should I be eating gluten-free carbohydrates?
  • Are artificial sweeteners safe?

If you’d like to submit your own question for discussion, please e-mail (note: this chat is for educational purposes only and is not medical advice.  For any personal health questions, contact your healthcare provider). 

The hashtag for this chat is #MGHDSME.  You can also follow us on Twitter: @MGHDiabetesEd

Guest Post, My Story

My Story: Finding a Support Group

Thanksgiving is the time of year when people reflect on the people and things they are thankful for in their lives.  One of our DSME support group participants, Anne, shares her story about how the support group has helped her learn how to better manage her Diabetes. 

Given her family history, she knew there was always a chance she would develop Diabetes and had already been preparing herself for that possibility.  After her diagnosis, her doctor mentioned the support group held every month at the MGH Diabetes Center.  Feeling the need to talk to other people who understand what it’s like to have Diabetes, and lacking a support group in her hometown, the decision to attend was easy.  

Something she noticed very quickly was several of her fellow group members were angry about having Diabetes, a feeling Anne didn’t share and couldn’t really understand.  Fearing a cancer diagnosis, learning she had Diabetes came as a relief—at least with Diabetes there was something she can do about it.  The way she looks at it, Diabetes keeps you on top of your health; now that she’s getting older, Anne knows she it’s especially important to pay attention to managing her Diabetes. 

Nevertheless, Anne insists that the group is made up of a great bunch of helpful, supportive people.  If you’re feeling down or having a bad day, she says, they have a way of bringing you up and helping you feel better.  She’s developed strong friendships with several members and they get together on occasion outside of group meetings.  

But what she enjoys most about the support groups is that every session is an opportunity to learn something new.  Sometimes it’s a new brand of pasta a fellow group member found, a new dessert recipe or a way to feel motivated to exercise.  Other times, it’s the way foods break down into glucose, the need to test her blood more often or the amount of sugar in fruit and yogurt.  One thing she was especially amazed to learn was how quickly exercise can lower blood glucose levels. 

Although it’s been several years since her diagnosis, Anne feels she hasn’t yet scratched the surface of what she can learn, especially with regards to her diet.  She rarely if ever misses a session, and hopes to continue to learn more about living well with Diabetes.  More than anything, Anne considers herself blessed to be at MGH.