490-P: Success of a Multidisciplinary Approach Strategy to Reach Target Glycemic Control in Patients with Uncontrolled Diabetes in a Rural Hospital in Thailand

Background: To prevent the late complications, achieving a target glycemic control is crucial and challenging, especially in a remote area with limited resource. We aimed to evaluate the efficacy of a multidisciplinary approach strategy to control blood sugar in these uncontrolled diabetes patients.

Method: During July 2019, we set up a team of volunteer including a diabetic educator and local healthcare providers such as doctors, nurses and pharmacists at a hospital in Northeast of Thailand. Forty patients with uncontrolled diabetes (HbA1c >7%) were selected to participate. Baseline characteristic, background knowledge and blood tests were obtained. All patients participated in a one day program learning hands on using blood sugar meter (Contour plus™) to monitor during diet control, medication issue, foot care and complication prevention. Two weeks later, we revisited and reviewed the daily blood sugar record at home and gave more advice. At 1 year, we collected the blood tests, medication list, and complication from medical records.

Results: Most participants were female (89.7%), age <60 years (61.5%) and overweight with BMI>23 kg/m² (53.8%). Comorbid disease including hypertension, dyslipidemia and chronic kidney disease were found in 66.7%, 23.1% and 25.6%, respectively. At 1 year, there was a significant improvement of blood sugar control (HbA1c <7%) compared to the baseline (18.2% vs. 64.9%, p<0.0001). The number of medication use mostly unchanged (64.4%), with 20.5% decrease and 12.8% increase. Of noted, there was improvement of renal function (GFR> 60 mL/min/1.73 m²) after better glycemic control (71.8% vs. 74.4%, p=0.032) and no new complication at 1 year.

Conclusions: Applying a short program of multidisciplinary approach strategy in uncontrolled diabetes patients at a rural hospital has proven an efficacy to improve target glycemic control. To make it sustainable is feasible by the local healthcare providers.