868-P: A Needs-Based Approach for Uncontrolled Hyperglycemia

Study Plan: Chronic uncontrolled hyperglycemia (defined as HbA1c >9% persistently) is common, even at specialty diabetes clinics. We hypothesized this group might respond to a coordinated multidisciplinary approach to target medical, educational, and psychosocial factors impacting their diabetes control. We recruited 27 such individuals to participate in a single multidisciplinary clinic (MDC) where they were seen by an endocrinologist, psychologist and educator who formulated a joint treatment plan after a 360 assessment. The patients were also screened for depression, anxiety and diabetes distress. Two other comparator groups (n=27 each) with baseline A1c>9% were formed. One group had individuals with identified psychological problems who received regular follow-up by a psychologist, endocrinologist, and diabetes educator. The second group received standard care from an endocrinologist and educator. All groups were followed out for 1 year, with hemoglobin A1c readings every 3 months, though many patients got the A1c less frequently.

Results: All groups had an improvement in the A1c over a year of follow-up. Compared to baseline, those in the MDC group had a greatest average lowering of hemoglobin A1c (-1.62), followed by the group with regular behavioral therapy (-1.23), while the group receiving standard care had the smallest improvement (-1.16). Importantly, the presence of depression, anxiety and diabetes distress was relatively low in the group with resistant hyperglycemia, and the degree of glycemic improvement had no correlation to the presence or absence of psychological problems.

Conclusion: A single multidisciplinary clinic visit with treatment planning can lead to substantial improvements in A1c, for those with resistant hyperglycemia and no apparent psychological problems. On the other hand, those with uncontrolled hyperglycemia not deemed to be “resistant” did quite well with usual care. Patients with identified psychological problems benefited from regular counseling by a behavioral therapist.