1427-P: Factors Predicting Significant Improvement in Glycemic Control after Endocrinology Referral in Patients with Type 2 Diabetes Mellitus and Hemoglobin A1c ≥ 10%

Endocrinology referral has been shown in several studies to significantly improve glycemic control in patients with uncontrolled type 2 diabetes mellitus (DM2). However, studies identifying factors that predict glycemic improvement are lacking. This is a retrospective study of adults (N =138, age ≥ 18 y) with DM2 who were referred to the Southern Illinois University Division of Endocrinology with initial HbA1c ≥ 10% and attended 6-month follow-up appointments. Patients who achieved HbA1c reduction ≥ 1% at 6-months were defined as the glycemic improvement group, while patients whose HbA1c fell by < 1% or increased were considered controls. There was no difference in mean initial HbA1c for the glycemic improvement (12.0 ± 1.6%) and control groups (12.0 ± 1.2%, P = 0.98). At the 6-month visit, 82% (113/138) of patients achieved glycemic improvement, with mean HbA1c 7.9 ± 1.7% for the improvement group and 12.2 ± 1.7% for the control group (P < 0.0001). There were no differences in demographics, insurance status, or comorbidities between the two groups. In a LASSO regression, factors that predicted glycemic improvement were proportion of endocrinologist appointments attended (OR 4.01, 95% CI 1.33-228.61), initiation of continuous glucose monitoring (OR 2.11, 1.11-45.86), proportion of dietitian and diabetes educator appointments attended (OR 1.91, 1.07-28.41), and initiation of a GLP-1 receptor agonist (OR 1.62, 1.04-11.71). Endocrinology referral significantly improves glycemic control for patient with DM2 and severe hyperglycemia, with compliance with appointments, initiation of CGM, and treatment with GLP-1 receptor agonists appearing to be key predictors of glycemic improvement.