Community-based management of complex type 2 diabetes: Adaptation of an integrated model of care in a general practice setting

Timothy M E Davis, Jocelyn J Drinkwater, P Gerry Fegan, Krishnamurthy Chikkaveerappa, Brett Sillars, Wendy A Davis

Research output: Contribution to journalArticle

Abstract

AIMS: To evaluate the effectiveness and patient acceptability of an integrated model of complex type 2 diabetes care delivered in a community-based general practice by upskilled general practitioners (GPs) co-located with an endocrinologist and diabetes nurse educator.

METHODS: Patients transferred from hospital clinic lists or referred by local GPs were assessed in clinics established in two southern Perth practices. An upskilled GP and endocrinologist developed a management plan which was communicated to the participant's usual GP. Up to two follow-up visits over 6 months were available to ensure that management was acceptable and effective.

RESULTS: 464 people with type 2 diabetes (mean±SD age 59.3±13.7 years, 52.2% males) were enrolled between November 2015 and March 2018. Their mean HbA1c was 9.3% (78 mmol/mol) and their mean body mass index 33.7 kg/m2 . There was an increase in use of injectable blood glucose-lowering therapies between the initial and final visit in association with a median HbA1c reduction of 1.2% (13 mmol/mol) which was sustained to 12 months in assessable participants. There were also reductions in blood pressure, and serum LDL-cholesterol and triglyceride concentrations. Patient satisfaction with current treatment, time for self-management, time spent in diabetes-related appointments, and knowledge of diabetes all increased significantly. Non-attendance for scheduled appointments was <10%. Local hospital referrals and waiting lists reduced over the study period.

CONCLUSIONS: This study confirms the potential value of integrated community-based care of the patient with complex type 2 diabetes which could represent a sustainable solution to overburdened hospital diabetes outpatient clinics. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalInternal Medicine Journal
DOIs
Publication statusE-pub ahead of print - 29 Oct 2019

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