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

Abstract

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 HbA1c >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 HbA1c goal of ≤8% (n=277) and those who did not (n=209) had a clinically significant decrease in HbA1c (‐3.13±1.80, ‐1.08±1.78). After adjustment, the following were associated with failure to achieve goal: higher admission HbA1c (%) 11.0±1.8 vs 10.3±1.7, AOR (95% CI) 1.22 (1.08, 1.37), p=0.0016; higher admission insulin (IU/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 (IU/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 HbA1c. 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. Copyright © 2010 John Wiley & Sons.

Diabetes Management For Low-Income Patients In Los Angeles: Two Strategies Improved Disease Control In The Short Term

“…It is yet to be determined whether or not these improvements can be sustained in primary care. Ruchi Mathur and colleagues(9) found that blood glucose control did not persist for a sample of patients followed a year after return to primary care, although LDL cholesterol reductions were maintained. That study was limited by small sample sizes in the follow-up population and included no comparison group.…”

Insulin initiation and management in people with Type 2 diabetes in an ethnically diverse population: the healthcare provider perspective

“…There is currently a shortage of evidence about healthcare professional‐related barriers to the use of insulin therapy in the management of people with Type 2 diabetes from different ethnic groups in the UK. Where ethnicity is discussed (for example, in relation to Hispanic groups in the USA [15] and in relation to patients from a range of ethnic minority backgrounds the UK [16]), the general view is that healthcare professionals perceive patients as being reluctant to accept insulin therapy because of cultural health beliefs and language barriers. In this paper, we aim to contribute to addressing this knowledge gap by reporting a qualitative exploration of the perspectives of healthcare professionals involved in the management of people with Type 2 diabetes in a multi‐ethnic setting, in Leicester, UK.…”