824-P: Does Utilization of a Three-Month Multidisciplinary Endocrinology Treatment Team Improve Glycemic Control and Reduce Therapeutic Inertia in High-Risk Patients with Diabetes Free

Elderly patients with diabetes and poor glycemic control are at higher risk of complications. We examined the effects of utilizing a 3-month multidisciplinary team, including an endocrinologist, diabetes educator, and pharmacist, on glycemic control in order to extend specialized care and reduce therapeutic inertia in high-risk patients cared for by primary care physicians. The purpose of our study was intensification of medical management of high-risk elderly patients with diabetes through a quality improvement (QI) project with HbA1c value as the primary outcome. We identified 176 patients with diabetes in our primary care clinics who were >/= 50 years old and had a HbA1C >/= 9%. Of these, 22 patients were agreeable to be scheduled to follow up with a provider in our Endocrinology and Metabolism Institute as a new patient. In April 2020, baseline data was obtained (HbA1c, Albumin: Creatinine, blood pressure, BMI, lipid panel and 10-year ASCVD risk %). They were then seen by an endocrinologist and sequentially followed up by a clinical diabetes educator and a pharmacist. At the end of 12 weeks, post-intervention data was collected. Patients were then followed by their primary care physician as needed.

Results: We enrolled 22 eligible patients with type 2 diabetes in our study. The mean age was 72 +/- 7 years with a pre-study HbA1c of 9.6 +/- 1.3%, BMI of 31.0 + 5.6 kg/m2, average albumin: creatinine of 195.1 +/- 298.3 mg/g. At the end of the study, the average HbA1c value was 7.6 +/- 0.9%, and represented a 2.0% decline (95% CI 8.0-9.3, p-value < 0.01). There was a 74.4 mg/g reduction in albuminuria (95% CI 61.1-282.4, p = 0.48) and a 0.5 kg/m2 increase in BMI (95% CI 29.0-33.4, p = 0.76).

Conclusion: Through use of a 3-month strategic multi-disciplinary QI initiative in high-risk patients with diabetes, we significantly improved glycemic control measured by HbA1c. A limitation of our study was the small study size.