Endocrine Abstracts

JOINT1781

Presentation: We report a case of a 40-year-old male admitted in April 2023 with left foot infection and an ulcer on lateral aspect of 5^th toe. Past medical history of Type 2 Diabetes Mellitus diagnosed age 25, Hypertension and Hypercholesterolaemia. Current medication Metformin 1g BD, Gliclazide 160mg BD, Canagliflozin 100mg OD, Ramipril 10mg OD and Atorvastatin 20mg OD. On admission HbA1c was found to be 138mmol/mol, patient was therefore referred to the in-patient diabetes nurses. Medication compliance was noted as an issue, considering foot infection insulin was commenced. Basic education and diet advice was given, patient was referred for additional support in the community. Patient declined insulin following discharge stating he would improve his diet and oral medication compliance to achieve better glucose control. At 12 weeks post discharge review in diabetic foot clinic and having been on oral antibiotics the foot infection had settled, and the ulcer was improving. HbA1c had reduced to 90mmol/mol. Patient advised to re-consider insulin but declined. At 18 weeks review, HbA1c rose to 110mmol/mol, patient admitted poor compliance with both diet and medication. Plan to start insulin at next clinic visit in 6 weeks as no Diabetes specialist nurse (DSN) available at the time. At 24 weeks review by DSN in diabetic foot clinic he had very limited blood glucose readings, patient still refusing insulin but agreed to a freestyle libre trial and close DSN phone follow-up. Patient again reported poor compliant with medication, high carbohydrate, sugar, and fat diet. Education was given regarding diabetes complications, diet and exercise impacts on blood glucose levels and the importance of medication compliance. At 25 weeks review we had further detailed discussion regarding glucose results, diet and lifestyle considering freestyle libre data in relation to post meal peaks and subsequent review with DSN 1 week later showed glucose to be 78% within target (4-10mmol/mol). Therefore, no changes to medication, patient to continue to work on improvements with lifestyle modifications. Further weekly phone support with DSN was scheduled. At 31 weeks review in joint foot clinic revealed foot infection fully resolved; foot wound completely healed with an HbA1c of 54mmol/mol.

Conclusions: Dedicated intensive input from DSN with freestyle libre improved challenging compliance issues. Thus, achieved significant improvement in glucose control, leading to complete wound healing while avoiding the need for insulin.