medwireNews: Full monitoring of biomedical and lifestyle-related diabetes target indicators is associated with significantly lower glycated hemoglobin (HbA1c) levels than incomplete monitoring among people with type 2 diabetes in a care group setting, say researchers.
Sytske van Bruggen (Leiden University Medical Center, the Netherlands) and co-authors explain that care groups were set up in the Netherlands to improve the delivery of structured primary diabetes care. The majority of general practices are members of a local care group, but participation is voluntary.
On an annual basis, the care groups facilitate “a quarterly diabetes consultation, in which diabetes-related target indicators are checked and lifestyle education is provided, combined with complementary allied health such as an annual foot check, fundus screening and dietician's counselling,” van Bruggen et al write.
However, they also note that “doubts on the clinical effects of registration are a barrier for full adoption of [type 2 diabetes] registration in general practice.”
To address this, the team compared HbA1c levels between fully monitored (n=8137) and incompletely monitored (n=3958) patients from the ELZHA cohort, which is derived from a care group comprising 167 general practices.
Full monitoring was defined as having each target indicator (HbA1c, systolic blood pressure, low-density lipoprotein cholesterol, BMI, smoking status, and exercise level) registered at least once between January and December 2014.
As reported in BMJ Open, fully monitored patients had significantly lower HbA1c levels than incompletely monitored patients, after adjustment for age, sex, and diabetes duration.
The difference was 2.03 mmol/mol (0.19%) among patients who had a target HbA1c value of 53 mmol/mol (7.0%) – those younger than 70 years and older patients with a mild treatment regimen (metformin monotherapy).
For patients aged 70 years and older on a more intensive treatment regimen, the difference was 3.36 mmol/mol (0.31%) among those with a diabetes duration of less than 10 years and a HbA1c target of 58 mmol/mol (7.5%), and 1.89 mmol/mol (0.17%) for patients with a longer diabetes duration whose HbA1c target was 64 mmol/mol (8.0%).
Van Bruggen et al say that “[t]hese differences might be expected to have a considerable clinical impact in terms of diabetes-related risks,” and may therefore “encourage awareness in GP [general practitioner] practice regarding adequate diabetes management and might help GPs to overcome barriers on full adoption of the care group monitoring approach.”
The researchers also point out that a missing registration among the incompletely monitored patients “does not necessarily reflect a lack of care but might be caused by technical or practical problems instead, [therefore] the associations found in this study might be underestimated.”
By Laura Cowen
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