Objective: To describe a novel integrated outpatient diabetes management system set up in China. To evaluate its effectiveness in type 1 diabetes (T1D) control.
Methods: A multiple disciplinary clinic, assembling a diabetologist, a diabetes education nurse, a dietitian, an ophthalmologist team, a psychiatrist, and a physiotherapist was set up to evaluate patient’s characteristics. The integrated outpatient care was carried out at baseline and every 3-6 months based on patient’s condition with an individualized principle tailored to meet each patient’s needs. Cross sectional data from type 1 diabetes patients attending the clinic through 2015 to 2018 were compared. Outcome measures included HbA1c levels, percentage of patients within HbA1c targets, quality of life score, and diabetes self-management score.
Results: A total of 749 T1D patients (380 children and 369 adults) attended the clinic within three years. Mean HbA1c level at baseline was 9.21±2.66%, with 93 (30.2%) children and 87 (26.4%) adults achieving HbA1c targets. 285 (44.7%) patients had an HbA1c level over 9%. Mean HbA1c declined by 1.44% - 1.85% within routine follow-up visits and remained stable at 7.36%-7.77% for up to three years (p<0.01). Percentage of children achieving HbA1c targets (<7.5%) increased to 67.3%. Percentage of adults achieving HbA1c targets (<7.0%) increased to 63.6%. Mean scores for self-management skills and quality of life increased significantly (p<0.05).
Conclusions: This new outpatient management system can significantly improve the overall diabetes control of T1D patients with sustainable influences. It is a dramatic improvement on T1D management over conventional clinics in China, and provides insights into a more rounded diabetes management model routinely involving six specialists.
Y. Xie: None. X. Li: None. F. Liu: None. Z. Zhou: None.
National Key Research and Development Program of China (2016YFC1305000, 2016YFC1305002, 2017YFC1309604)