Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized...

Area of Science:

• Endocrinology
• Internal Medicine
• Public Health

Background:

• Poorly controlled type 2 diabetes poses a significant challenge for healthcare providers.
• Identifying factors contributing to treatment non-response is crucial for effective diabetes management.

Purpose of the Study:

• To evaluate the efficacy of an interdisciplinary mobile clinic approach for poorly controlled type 2 diabetes.
• To characterize patients who are refractory to standard diabetes treatment.

Main Methods:

• A 6-month randomized controlled trial comparing an interdisciplinary mobile clinic (WNMDCP) with usual care in two primary-care clinics.
• Inclusion criteria: Hemoglobin A1c (HbA1c) ≥10%.
• Outcomes measured: HbA1c reduction (≥0.5%), plasma glucose levels, treatment compliance, and response rates.

Main Results:

• The intervention group showed significant improvements in plasma glucose (-1.5 mmol/l) and HbA1c (-1.8%) compared to the control group (p<0.0001).
• Compliance and response rates were substantially higher in the intervention group (85% and 71%) versus the control group (32% and 35%).
• Over 70% of patients in the intervention group responded positively to the interdisciplinary treatment.

Conclusions:

• The Western Negev Mobile Clinic Diabetes Program's interdisciplinary approach is effective in improving glycemic control in patients with poorly controlled type 2 diabetes.
• Non-responders were primarily associated with poor compliance or significant comorbidities limiting mobility.
• This model offers a promising strategy for managing complex diabetes cases in underserved areas.