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Metabolic control of diabetes in a diabetes centre
W M S Lam1, J K Y Li, A Y S Leung
1Department of Medicine and Geriatrics, Yan Chai Hospital, 7-11 Yan Chai Street, Tsuen Wan, Hong Kong.
Insights
A diabetes centre effectively improved metabolic control in patients with poorly controlled diabetes, significantly reducing glycated haemoglobin levels. Newly diagnosed diabetes was a predictor of a favourable glycaemic response.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Public Health
Background:
- Poorly controlled diabetes poses significant health risks.
- Effective management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a dedicated diabetes centre in Hong Kong.
- To assess the impact on metabolic control in patients with poorly controlled diabetes.
Main Methods:
- Retrospective review of medical records from a district hospital's diabetes centre.
- Analysis of glycated haemoglobin (HbA1c) levels, body weight, blood pressure, and lipids.
- Inclusion of 185 patients, predominantly with type 2 diabetes.
Main Results:
- Mean glycated haemoglobin (HbA1c) reduced from 10.4% to 8.2% (2.2% reduction, P<0.0005).
- Among discharged patients (n=81), mean HbA1c was 7.5%, with a 2.8% reduction (P<0.0005).
- 30.9%, 53.1%, and 77.8% of discharged patients achieved HbA1c <7.0%, <7.5%, and <8.0%, respectively.
Conclusions:
- The diabetes centre effectively managed a diverse group of patients with poorly controlled diabetes.
- Newly diagnosed diabetes was the sole predictor of a favourable glycaemic response.
- Specialized diabetes centres can restore metabolic control in challenging patient populations.
Objective:
To examine the effectiveness of a diabetes centre in restoring metabolic control in patients with poorly controlled diabetes.
Design:
Retrospective review of medical records.
Setting:
Diabetes centre of a district hospital, Hong Kong.
Participants:
Patients with poorly controlled diabetes referred to a diabetes centre.
Main Outcome Measures:
Primary endpoints were mean change in glycated haemoglobin levels and the number of patients who achieved glycated haemoglobin levels of 7.0% or lower, 7.5% or lower, and 8.0% or lower, respectively. Complementary endpoints were serial changes in body weight, blood pressure, and lipids.
Results:
One hundred and eighty-five patients, predominantly with type 2 diabetes (94.6%), were reviewed. Median duration since diagnosis of diabetes was 8 years (interquartile range, 4.3-11.8 years). Seventy-three patients had a body mass index of 25 kg/m(2) or higher. The baseline and latest glycated haemoglobin levels were 10.4% (standard deviation, 2%) and 8.2% (1.4%), respectively; mean reduction was 2.2% (95% confidence interval, 1.9-2.5; P<0.0005). Eighty-one patients were discharged after a median 32 weeks of follow-up. Their mean glycated haemoglobin level on discharge was 7.5% (0.8%), and the mean reduction was 2.8% (95% confidence interval, 2.4-3.3; P<0.0005). The cumulative percentages of discharged patients who achieved glycated haemoglobin levels of less than 7.0%, 7.5%, and 8.0% were 30.9%, 53.1%, and 77.8%, respectively. Newly diagnosed diabetes (P=0.006) was the only factor which predicted a favourable glycaemic response. CONCLUSION. The Diabetes Centre provided effective management for a heterogeneous group of patients referred with poorly controlled diabetes.