medwireNews: Patient-controlled diabetes management improves diabetes-related wellbeing and reduces face-to-face visits and non-attendance without negatively impacting glycemic control and other clinical outcomes, Danish researchers report.
The findings suggest “that standard diabetes care follow-up could be switched to people-initiated contacts while maintaining safe disease management, in line with similar reports concerning other chronic illnesses,” write Tinne Laurberg (Steno Diabetes Centre Aarhus) and co-authors in Diabetic Medicine.
Laurberg and team evaluated the impact of DiabetesFlex care in 160 randomly assigned individuals (mean age 48 years, 49% women) with type 1 diabetes.
They explain that DiabetesFlex involves an initial face-to-face consultation with an endocrinologist and a specialist diabetes nurse. Participants are then given the option to convert some of their subsequent face-to-face appointments to telephone consultations or cancel them altogether.
Two weeks prior to each visit, participants completed the internet-based, AmbuFlex diabetes-specific, patient-reported outcome questionnaire, which allowed a specialist diabetes nurse to determine whether it was clinically safe to change or cancel a consultation, in line with the participants’ requests.
The researchers report that individuals in the DiabetesFlex group had 22% fewer face-to-face visits (n=284 vs 372) during the 15-month study period than the 160 participants randomly assigned to receive standard care (face-to-face visits every 4 months), owing to an increase in telephone consultations.
They also cancelled more visits (17.0 vs 8.7%); and were less likely to miss an appointment without cancellation (2.3 vs 8.2%).
Of note, there were four occasions where the specialist nurse deemed it potentially unsafe for a participant not to have a face-to-face consultation despite them choosing to switch or cancel.
Mean glycated hemoglobin (HbA1c) levels increased from 7.44% (57.79 mmol/mol) at baseline to 7.47% (58.21 mmol/mol) at the 15-month assessment in the DiabetesFlex participants, and the investigators found that this was not significantly different from the change observed with standard care.
In the standard care group, mean HbA1c increased from 7.36% (56.91 mmol/mol) to 7.42% (57.57 mmol/mol), and the resulting mean difference of 0.03% (−0.27 mmol/mol) in the change from baseline between the two groups fell below the predefined noninferiority margin of 0.4%, Laurberg et al note.
The investigators also report that there were no significant differences between the two groups in the change in lipid levels or blood pressure, nor in diabetes treatment or the use of technologies.
There were, however, significant improvements in mental wellbeing (World Health Organization-5 well-being index), diabetes distress (Problem Areas In Diabetes questionnaire), and participation in own care with DiabetesFlex versus standard care.
At the end of the study, 94% participants in the DiabetesFlex group chose to continue with the DiabetesFlex plan, while 54% of those in the standard care group decided to switch.
Laurberg and co-authors conclude that, for people with well-controlled type 1 diabetes and good psychological wellbeing, the DiabetesFlex strategy “could improve diabetes treatment by increasing involvement […] and minimizing health care–related disruptions to people's lives.”
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