Improvement noted after a multifaceted approach to diabetes mellitus management

Abstract

Background: Optimal control of diabetes mellitus remains elusive, especially in developing countries. A comprehensive and standardised approach, coupled with intensive patient and clinician education, may provide the solution.

Methods: Comprehensive datasheets accompanied by patient education from a multidisciplinary team and clinician retraining on diabetes management was introduced into the Edendale Hospital diabetes clinic in 2012. This study compares diabetes control starting October 1, 2012 to September 30, 2013 (Y1) to October 1, 2013 to September 30, 2014 (Y2).

Results: Significant changes (p-values < 0.005) were noted in the following parameters between Y2 and Y1 respectively:
* Mean HbA1c% (10.41 ± 2.91 vs. 11.26 ± 2.99).
* Mean HbA1c in males (9.46 vs. 10.57) and (10.38 vs. 11.19) for females.
* Mean HbA1c for type 1 (11.80 vs.10.77) and type 2 patients (10.91 vs.10.10).
* Percentage of patients achieving triglyceride control (64.28 vs. 52.85).
* Percentage of patients making lifestyle changes and performing home glucose monitoring.
* Increase in female waist circumference (97.29 vs. 85.95 cm).
* Increase in BMI in males (29.65 vs. 27.92 kg/m²).

Conclusion: This multifaceted approach to diabetes care in a resource-limited clinic significantly improved glycaemic and triglyceride control. Obesity remains a major challenge. This model could serve as a blueprint for other such resource-limited clinics.