Endocrine Abstracts

Background: It is well established that diabetes-related complications are greatest in patients with a high HbA1c and in those who do not attend primary or secondary care clinics. For an equivalent reduction in HbA1c greater benefits are achieved in those with a high baseline.

Aim: To determine if a simple action plan implemented by the Diabetes and Practice Nurse in primary care could improve glycaemic control.

Methods: A primary care surgery in North Northumberland was approached. The Diabetes and Practice nurses reviewed the computerised records of all patients registered at the surgery with an HbA1c≥7.5%. An action plan was constructed and instigated. 12 patients were referred to secondary care, 11 patients attended a dietician-led community pre-insulin assessment (5 of which were subsequently commenced on insulin), 9 were found to be house-bound and were visited at home. The remainder had a simple stepped-approach to increase oral hypoglycaemic therapy. HbA1c results were reviewed 6 months later.

Results: 481 patients with diabetes were identified. 107 patients (22.3%) had an HbA1c≥7.5% (mean 9.0+/−1.6); 26 (24%) of these had an HbA1c ≥10% (the “high HbA1c group”, mean 11.2+/−1.4). 80 of the 91 patients with follow-up data had an improved HbA1c. Mean HbA1c in the whole cohort was 8.1+/−1.7 (P<0.001 by ANOVA for change from baseline), and in the high-HbA1c group mean HbA1c was 9.4+/−2.4 (P<0.001 by ANOVA for change from baseline).

Conclusion: Simple, brief, inexpensive interventions and close liaison with primary care can lead to significant improvements in HbA1c. In the high HbA1c group a mean reduction of 1.8% is much better than that achieved in pharmaceutical trials of new therapeutic agents and is likely to have a major impact on complication rates. Such an approach is advantageous to the patient, secondary care and not least primary care in view of the new GMS contract.