14 May 2018

Specialist drop-ins for diabetes patients win plaudits

Clinical Diabetes

A new form of joint case conferencing for diabetes, which received stellar reviews from GPs and patients, has been associated with a decrease in diabetes markers, including HbA1c, over a three-year period.

The program, rolled out across 50 practices in western Sydney, brought a specialist team to GPs’ doorsteps with the aim of upskilling diabetes care.

The specialist team, which includes a diabetologist and diabetes nurse educator, sat with the GP, patient, and often the practice nurse, and provided tailored advice on lifestyle changes, managing psychological issues, and changes to medication.

The team also helped build confidence around moving patients with diabetes from oral to injectable medications, as well prescribing GLP-1 analogues, weekly injections to help with weight loss.

“What was contained in those conversations would all depend on what the GP wanted to know,” Professor Glen Maberly, a senior endocrinologist and program lead at Western Sydney Diabetes, said.

Each session was only 30-minutes for the patient, but GPs would sit through multiple consultations with different patients throughout the day.

At the end of the sessions, GPs were given a telephone support line, which connected them with experts who could help them with decision making, especially around insulin dose adjustment. Often, the diabetes nurse educator would return to the GP clinic to offer follow up training for the practice nurse.

Patients who were involved in the program saw a 0.87% drop in blood sugar levels (HbA1c) over a six-month period. This was sustained at three years, along with improvements in weight, cholesterol and blood pressure.

“Almost 1% means fairly dramatic improvement in terms of prevention of heart attack, stroke and the complications of diabetes,” Professor Maberly said. “So we found that one intervention to be surprisingly effective.”

In a paper recently published in the Journal ofIntegrated Care, Professor Maberly and his team described the flow-on effect of the program to other patients.

Involvement in the program was associated with a 7.5% reduction in the proportion of patients at the GP clinic without a recent HbA1c test, as well as an increase in the proportion of patients on lipid-lowering medication.

There was an uptick in the proportion of patients with poorly-controlled diabetes, but the researchers speculated that this was because the program increased the number of patients being diagnosed with diabetes.

The study wasn’t run as a randomised controlled trial due to lack of resources, so the results have to be taken with a grain of salt (the same improvements in care may also have occurred in GP practice that did not join the program).

However, the program was a resounding success from the perspective of GP and patients, who gave very positive reviews in surveys.

“Virtually all patients who responded [about 50%] reported that they were happy with the service and thought that it would be useful for them in managing their diabetes,” the authors wrote.

“Doctors were almost universally pleased with the program, and often wrote quite lengthy endorsements on their response sheet.”