medwireNews: A type 1 diabetes outpatient model in which patients decide the frequency and timing of their own appointments was well received and did not affect clinical outcomes in the DIATAST randomized controlled trial.
The 2-year Danish study included 357 adults with a type 1 diabetes duration of at least 6 months and without unstable complications who were randomly assigned to take part in the patient-initiated appointment intervention or to receive usual care. Patients in the intervention group had unlimited access to online self-booked outpatient appointments and glycated hemoglobin (HbA1c) testing, while those in the control arm had regular prescheduled visits as determined by healthcare providers.
As reported at the virtual 56th EASD Annual Meeting, participants in the intervention group were significantly more likely to report being able to get an appointment when needed than those in the control group. The average scores on a Likert scale of 1 (strongly agree) to 5 (strongly disagree) were 1.5 versus 1.9 at the 2-year follow-up.
Moreover, patients in the intervention arm were significantly more likely to be satisfied with the benefits of the consultation than those in the control group, with average scores on the Likert scale of 1.6 and 1.7 points, respectively.
Nina Drojdahl Ryg (Hospital South West Jutland, Esbjerg, Denmark) reported that the intervention significantly reduced the number of outpatient clinic visits. Participants taking part in the intervention attended appointments with a physician, nurse, or dietician a median of four times over the study period, compared with six in the control group. The median number of telephone contacts was higher in the intervention arm, however, at two versus one. Patients in the intervention group were also less likely to report unnecessary clinic visits than those in the control arm.
The presenter said that these changes occurred “with no deterioration [of] clinical diabetes variables.” Average HbA1c levels remained largely consistent throughout the study, at 59.7 mmol/mol (7.6%) at baseline and 60.5 mmol/mol (7.7%) at 2 years in the intervention group, and 59.7 (7.6%) and 59.4 mmol/mol (7.6%), respectively, in the control group. There were no significant differences in HbA1c levels, low-density lipoprotein cholesterol, albuminuria, or blood pressure between the two groups.
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