Endocrine Abstracts (2012) 28 P230

Devolving diabetes care to general practice

Arshad Hussain, Maeve Durkan, Hamed Alarrayed & Jude Asfour

Endocrinology, Portiuncula Hospital, Ballinasloe, Ireland.

In Ireland, we are devolving management of diabetes to primary care. Recent studies highlight the importance of early glycemic (metabolic memory) & multifactorial control. Our hospital‘new’patient waiting lists average 18 months and for ‘best practice’, this is “time lost”. We established a pilot program for a rapid assessment to reduce waiting times and ensure specialist input. This is a retrospective review of our 50 patients thus far. 30% were women and 70% male. 6% had DM1, 94% had DM2. 8% of patients were aged <40 years, 52% were 41–60 years; 32% were 61–75 and 4% were over 75 (60% of cohort aged <60 years.) 12% of patients had normal BMI, 78% were overweight/obese and 10% were super-obese. 58% were diagnosed within the previous 2 years,and a further 10% within 2–5 years, 16% within 5–10 years. 16% had DM for over 10 year. 22% had an HbA1c of <6.5%, and a further 14% of 6.5–7%.74% had an HbA1c exceeding recommended targets of 7%. 15% had an HbA1c of 7–8%, 22% and HbA1c of 8–10%, and 37% exceeding 10%. The average HbA1c was 8.2% in those with duration of DM <1 year, trending up to 8.5% with duration of <2 years. 30% had undiagnosed complications. 2% had retinopathy, 16% had neuropathy, 12% had nephropathy (Avg A1c of 7.67% in those with low eGFR vs 7.18% without, and 8.74% in with micro albuminuria vs 8.1% in those without) 52% had treated hypertension.76% of patients had BP readings exceeding the guidelines of 130/80 and 64% exceeded 140/90, of whom 24.1% only were on treatment. 56% had treated hyperlipidemia, but 68% had LDL values >2.0 mmol (74%>1.8 mmol). In summary, patients are young, obese and have poor control. Almost 75% exceed recommended HbA1c targets, which is ‘time lost’. Almost 75% have poor BP control; almost 70% have poor lipid control, and those on treatment are inadequately treated. This emphasizes the concern of delegation of management without a defined algorithm that must serve as a regular checklist for care.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Rapid Assessment Data vs ADOPT Data

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.

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