Effectiveness of a locality-based integrated diabetes care service on clinical outcomes

Aims: To evaluate the effectiveness of a new locality‐based integrated diabetes care service for people with Type 2 diabetes in an inner regional area. Methods: A quasi‐experimental evaluation comparing baseline and follow up clinical data collected from general practices and specialist services participating in an integrated diabetes care programme in an inner‐regional area. Patients had at least one specialist service consultation. The primary outcome was glycated haemoglobin (HbA1c). Results: Clinical data were collected for 178/239 patients (74.5% participation; aged 65± 11(SD) years, 46% female; median [interquartile range (IQR)] diabetes duration 19 (11.0‐24.0) years from seven general practices over 33 months (median 18.5 months). There were reductions in HbA1c ‐0.7±1.6 % (8±18 mmol/mol) (p<0.001), systolic blood pressure ‐5.8±19.5 mmHg (p<0.001), diastolic blood pressure ‐2.4±14.3 mmHg (p=0.04), total cholesterol ‐0.5±1.3 mmol/l (p<0.001), low‐density lipoprotein (LDL) ‐0.4±0.9 mmol/l (p<0.001), Body Mass Index ‐0.5±1.6 kg/m2 (p<0.001), weight ‐1.8±4.7 kg (p<0.001). Urine albumin creatinine ratio [median (IQR)] at baseline was 3.0 mg/mmol (0.7‐7) vs follow up 1.9 mg/mmol (0.8‐5.5) p< 0.54). Conclusions: Glycaemia and cardiovascular risk factors can be reduced in patients with long‐standing Type 2 diabetes by moving to a locality based integrated primary‐secondary care diabetes care service.