Effectiveness of Diabetes Case Conferencing Program on Diabetes Management

Abstract

Aims: Diabetes case conferencing is where an endocrinologist visits a general practitioner (GP) to advise on the care of patients with diabetes. Past case conferencing studies have reported improved diabetes management and clinical outcomes in primary care. This study investigated the effectiveness of a diabetes case conferencing program in South Western Sydney, Australia. Methods: CComplex diabetes cases were referred by general practitioners to a visiting endocrinologist for review after obtaining patient consent. The patient was not usually present. After the case discussion, a diabetes management plan was developed jointly by the general practice/specialist team. Clinical data were compared at baseline and each year up to three years (2017–2020) after the consultation using paired t-test. The primary outcome was HbA1c. Results: Clinical data were collected for 645/775 patients (mean age 64± 15(SD) years; 351 (54.4%) males from 40/43 general practices; 96.4% had type 2 diabetes; 6.5% were insulin treated, 54.3% non-insulin treated, 31.5% both insulin and non-insulin treated and 3.4% diet only. There were reductions in HbA1c by 1.0±1.7% (11±19 mmol/mol) (p<0.001), systolic blood pressure 8.2±18.1 mmHg (p<0.001), diastolic blood pressure 2.7±11.6 mmHg (p<0.001), total cholesterol 0.2±1.7 mmol/l (p=0.007), low-density lipoprotein 0.2±1.0 mmol/l (p<0.001), weight 3.3±10.1 kg (p<0.001) and body mass index (BMI) 1.3±3.5 kg/m2 (p<0.001). Conclusions: Glycaemia, weight and cardiovascular risk factors improved following case conferencing consultations in a primary care setting.

Keywords

• diabetes mellitus
• type 2 diabetes mellitus
• clinical effectiveness
• endocrinologist
• integrated health care system
• multidisciplinary care team
• primary health care