1178-P: Multicomponent Integrated Care Program Benefits on Cardiovascular Risk Factors for Adults with Diabetes and High Cardiovascular Risk: The DIABEMPIC Program

Cardiovascular disease (CVD) is a major cause of death/disability in people with diabetes, this impact could be even greater in low- middle-income countries, where large gaps exist in achieving diabetes care goals. We examined a quality initiative Multicomponent Integrated Care (MIC) program (DIABEMPIC, DIABetes EMPowerment and Improvement of Care) on diabetes care goals in persons with type 2 diabetes (PwT2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-months empowerment-based program with the following components: interdisciplinary case management team, diabetes self-management education and support, individual/group sessions, shared medical appointments, patient-centered approach, audit and feedback, and guaranteed supply of medications. We evaluated the effect of the intervention on the improvement in diabetes care goals using a ’before and after’ design in participants with a high CV risk.

Results: total PwT2D were 610, of which 375 (61.1%) had high CV risk (10-year risk of cardiovascular disease ≥10% with Globorisk lab score). The mean (SD) age of this subgroup was 59.3 (9.4) years, 66% female, 56% had elementary or less education, 73% had medium-low or lower socioeconomic status. Mean diabetes duration was 13 (8) years, 21.8% with current smoking status, 61% with hypertension diagnosis. After the intervention systolic and diastolic blood pressure (-12, -4 mmHg respectively), A1c (-2.4%), triglycerides (-40 mg/dl), and non-HDL cholesterol (-36 mg/dl) decreased significantly (p<0.0001).

Conclusions: We found a high prevalence of high risk for CVD in primary care. This quality of care initiative had a valuable effect on CV-related diabetes care goals in a real-world setting. MIC strategies may play an important role to mitigate CVD burden in high-risk populations. We suggest further replications of this intervention.