Western Negev Mobile Diabetes Care Program: a model for interdisciplinary diabetes care in a semi-rural setting

We describe a mobile diabetes clinic aimed to provide comprehensive, interdisciplinary care to patients with diabetes resident on a semi-rural area. A mobile, tertiary care diabetes clinic, composed of a diabetologist, a diabetes nurse-educator and a dietitian, was created. The clinic regularly visited the primary-care facilities of 3 towns of the Western Negev, a semi-rural area of southern Israel. A standardized, computer-based clinical protocol was applied. Analysis of data was performed on records of all patients who had had at least 2 visits to the clinic. Of 492 patients who met the inclusion criteria, 93.6% were diagnosed with type 2 diabetes, 58% were female, the mean age was 60 years and the mean time after diagnosis of diabetes was 10 years. Most patients had not visited a diabetes center before implementation of the mobile clinic. Parameters of clinical practice such as nutritional advice by a dietitian, interaction with a diabetes nurse-educator, performance of periodic ophthalmologic examination, and measurement of microalbumin excretion improved dramatically after opening of the mobile clinic. Modifiable clinical variables such as body mass index (p<0.0001), systolic (p<0.001) and diastolic (p<0.05) blood pressures, fasting plasma glucose (p<0.001), hemoglobin A1c (p<0.01), LDL-cholesterol (p<0.01) and HDL-cholesterol (p<0.0001) improved significantly after implementation of the program. The implementation of a mobile diabetes care program in an area of low-density population is feasible. Significant improvement in parameters of clinical practice and of modifiable variables of diabetes control was achieved. The mobile diabetes clinic brought the interdisciplinary diabetes-care team to the patients' area of residence. Limited manpower answered the requirement of a geographically spread population.