Efficacy of a staged diabetes management programme in achieving glycaemic goal in a low socio-economic Hispanic population

摘要

The aim of this study was to identify the efficacy of a staged diabetes management (SDM) clinic serving a low socio-economic Hispanic population in achieving glycaemic goal. We analysed prospectively collected data from patients discharged from the clinic in 2008 with an admission HbA_(1c) >8% (64mmol/mol) and >one clinic visit. Adjusted odds ratios (AOR) were determined for factors significantly associated with glycaemic goal achievement. Both those patients who achieved the clinic HbA_(1c) goal of <8% (n=277) and those who did not (n=209) had a clinically significant decrease in HbAic (-3.13+-1.80, -1.08+1.78). After adjustment, the following were associated with failure to achieve goal: higher admission HbA_(1c) (%) 11.0+-1.8 vs 10.3+-1.7, AOR (95% Cl) 1.22 (1.08,1.37), p=0.0016; higher admission insulin (lU/kg/day) 0.56+-0.58 vs 0.26+-0.41, AOR 2.08 (1.09, 4.00), p=0.026; greater increase in insulin (lU/kg/day) 0.23+-0.46 vs 0.09+-0.32, AOR 2.38 (1.15, 5.00), p=0.02; and a longer stay (days) 229+-110 vs 172+-84, AOR 1.007 (1.003,1.012), p=0.0008. In this SDM clinic, most patients achieved significant reduction in HbAic. The study identified factors associated with a lower likelihood of achieving goal thereby demonstrating the value of review of the response to an SDM protocol in indicating areas for further improvement.