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Specialty care improves metabolic control in adults with diabetes
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Patients with type 2 diabetes newly referred to a diabetes specialty center had significantly worse metabolic control than those with diabetes in the general population, but they showed an improvement in HbA1c, blood pressure and LDL after 1 year of therapy, study data show.
“These data support the role of endocrinologists and multidisciplinary specialty practices in the care of adults with uncontrolled type 2 diabetes, as well as those with multiple comorbid cardiovascular risk factors,” the researchers wrote.
Sanjeev N. Mehta, MD, MPH, of the section of genetics and epidemiology at Joslin Diabetes Center in Boston, and colleagues evaluated data from the National Health and Nutrition Examination Survey (n = 1,674) and a diabetes center (n = 3,128) from 2005 to 2010 on adults with type 2 diabetes. Data from NHANES was used for the general sample.
Researchers sought to determine metabolic controls in adults with diabetes in the general population compared with those newly referred to a diabetes center after 1 year of specialty care.
Compared with the general sample, patients from the diabetes center were less likely to have HbA1c less than 7% at baseline (P < .001), to be prescribed glucose-lowering medications (P < .001), to have BP less than 130/80 mm Hg (P < .001) and to be prescribed antihypertensive medications (P< .001). HbA1c, BP and LDL cholesterol control was more than threefold higher in the general sample compared with diabetes center patients at baseline (P < .001). LDL cholesterol was similar between the two groups at baseline.
Targets for HbA1c, BP, LDL and all combined were reached by more diabetes center patients after 1 year compared with baseline (P < .001) for all.
“New referrals for diabetes specialty care demonstrated worse metabolic control, notably higher HbA1c levels, compared to adults with diabetes in the general population,” the researchers wrote. “After 1 year of specialty care, there were improvements in HbA1c, BP, LDL control and a 2.7-fold improvement in simultaneous [HbA1c, BP and LDL cholesterol] control. Metabolic improvements were found in the context of significant medication intensification. Sustained improvements in metabolic control have been associated with reductions in diabetes complications and overall health care expenditures.” – by Amber Cox
Disclosure: Mehta reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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