Introduction: St Vincent’s Hospital (Sydney) Diabetes Centre has delivered an insulin dose titration program since 1979. The IDA Clinic is a core part of the Diabetes Centre’s activity operated by a Diabetes Nurse Educator (DNE) Monday to Friday from 8am to 12 midday. The benefit of this clinic to patient glycaemic outcomes had not been established.
Objective: To determine whether participation in the IDA clinic improves glycaemic outcomes.
Methods: All patients enrolled in the IDA Clinic from 13 April to 12 October 2016 (26 weeks) were audited. The following data was collected on all enrolled patients: age, diabetes type, enrolment date, discharge date, HbA1c pre-enrolment and ≤ 6 months post-discharge and whether patient achieved target BGLs.
Results: We enrolled 172 patients. Mean age was 59 y (range 18-91). Seventy-two percent (n=123) had type 2 diabetes, 22% (n=38) had type 1 diabetes, 4% (n=7) had steroid-induced diabetes and 2% (n=4) had other diabetes. Average length of stay in the clinic was 9 weeks (range 0-28). Of those enrolled, 109 had pre- and post-clinic HbA1c data available. Of these, 69% (n = 75) completed the programme (determined by achieving target blood glucose levels).
As shown in the table, there was a significant improvement in glycaemic control (1.3% reduction in HbA1c) after participation in the IDA Clinic (P<0.001). There was a significantly greater improvement in HbA1c in completers versus non-completers (P=0.02).
|
|
Mean HbA1c % (mmol/mol) pre-enrolment |
Range |
Mean HbA1c % (mmol/mol) post-discharge |
Range |
P-value |
|
All patients (n=109) |
9.4 (79) |
6.3-16.7 (45-159) |
8.1 (65) |
5.0-11.3 (31-100) |
P<0.001 |
|
Completers (n=75) |
9.5 (80) |
6.3-15.6 (45-147) |
7.9 (63) |
5.0-11.3 (31-100) |
P<0.001 |
|
Non-completers (n=34) |
9.2 (77) |
6.8-16.7 (51-159) |
8.5 (69) |
5.9-11.1 (41-98) |
P=0.05 |
Conclusion: Enrolment in an insulin dose adjustment program improves glycaemic control in the short-term. Future analysis will determine whether this benefit is maintained.