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

• Published in: Internal medicine journal
• Main Authors: Zarora, Reetu, MacMillan, Freya, Piya, Milan K, Fernandes, Brunelle, Simmons, David
• Format: Journal Article
• Language: English
• Published: Australia 20-01-2021
• Subjects: integrated delivery of healthcare; rural health services; primary health care; Type 2 diabetes mellitus; programme evaluation
• ISSN: 1445-5994

Diabetes management often requires close cooperation between primary and specialist services, but a range of challenges in Australia and elsewhere make seamless care difficult.
To evaluate the effectiveness of a new locality-based integrated diabetes care service for people with Type 2 diabetes in an inner regional area.
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).
Clinical data were collected for 178 (74.5%) of 239 patients (age ± standard deviation, 65 ± 11 years; 46% female; median (interquartile range) 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 (0.4 ± 0.9 mmoL/L; P < 0.001), body mass index (0.5 ± 1.6 kg/m
; P < 0.001) and weight (1.8 ± 4.7 kg; P < 0.001). The proportion without microalbuminuria increased from 48.4% to 59.3% (P = 0.03).
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.