Specialist-Led Diabetes Registries and Prevalence of Poor Glycemic Control in Type 2 Diabetes: The Diabetes Registry Outcomes Project for A1C Reduction (DROP A1C)

Abstract

OBJECTIVETo highlight the utility of a large patient registry to identify functionally refractory patients (persistent HbA 1c ‡75 mmol/mol [9.0%]) with type 2 diabetes, identify their barriers to glycemic control, and implement barrier-specific care path strategies to improve glycemic control. RESEARCH DESIGN AND METHODSA working group developed a structured tool to optimize the collection of information on barriers to glycemic control and designed structured care paths to address each barrier. Participants were identified from a large Canadian registry and were assigned to a certified diabetes educator (CDE) as their case manager for a 12-month period to coordinate assessment of their barriers and to implement appropriate care path strategies. The primary outcome measure was the mean change in HbA 1c from baseline at 12 months. RESULTSOverall, 3,662 refractory patients were initially identified of whom 1,379 were eligible for inclusion and 155 enrolled. The most common barrier categories participants identified were psychological/support (93%), socioeconomic (87%), and accessibility (82%), with high concordance (75-94%) between participant and CDE. No specific barriers were predictive of hyperglycemia. After implementation of barrier-specific care paths, the mean reduction in HbA 1c at 12 months was 17 mmol/mol (1.5%; P < 0.01 vs. baseline) versus only 5 mmol/mol (0.5%) in the source cohort (n = 966) who continued with standard care. The incidence of severe hypoglycemia did not change significantly during the study. CONCLUSIONSIn registry-identified hyperglycemic patients with type 2 diabetes, the use of barrier-specific care paths significantly improved glycemic control in otherwise refractory patients with persistently elevated HbA 1c . Further studies using this strategy in other practice settings are warranted.

Glucose Control in Diabetic Patients Attending Parirenyatwa Group of Hospitals in Zimbabwe

“…Poor glycaemic control is expected to become more prevalent later in life due to limited physical activity or nonadherence to treatment [22,25]. There was, nevertheless, no significant association between age and glycaemic control in the current study ( Table 2).…”

Assessment of self-management in patients with diabetes using the novel LMC Skills, Confidence and Preparedness Index (SCPI)

“…The LMC Skills, Confidence & Preparedness Index was developed in response to several needs in patient education. An assessment tool that could better identify specific patient gaps and barriers would allow better individualization of support strategies and teaching, as recently demonstrated in the DROP A1C study [5]. A tool that could measure patient confidence and preparedness, beyond just current behaviour, and still correlate consistently to accepted clinical outcomes, such as glycemic control, would allow better triaging of patients into appropriate interventions.…”

“…The unique challenge to optimal diabetes self-care, is the requisite integration of multiple skills and behavioural changes. The recent Diabetes Registry Outcomes Project for A1C Reduction (DROP A1C) study [5] of refractory patients used the Barriers to Care Index and found that when barriers were correctly identified, individualized care paths could be successfully implemented, and significant improvements in previously refractory glycemic control were possible. Interestingly, no one barrier or barrier category (psychological/support, socioeconomic, comorbidity, accessibility, cultural) was associated with greater likelihood of response, implying that each barrier could be equally overcome with appropriate care path individualization.…”

Real-World Health Outcomes of Insulin Glargine 300 U/mL vs Insulin Glargine 100 U/mL in Adults With Type 1 and Type 2 Diabetes in the Canadian LMC Diabetes Patient Registry: The REALITY Study

“…The registry contains sociodemographic information, medical history, prescriptions and laboratory investigations. A detailed description of this registry has been previously described (8,9). Patients provided written consent for their electronic medical records to be used for research purposes, and this study was approved by a local ethics review board.…”