Hong Kong Med J 2002;8:419-26 | Number 6, December 2002
Metabolic control of diabetes in a diabetes centre
WMS Lam, JKY Li, AYS Leung, WK Kwan
Department of Medicine and Geriatrics, Yan Chai Hospital
OBJECTIVE. To examine the effectiveness of a diabetes centre in restoring metabolic control in patients with poorly controlled diabetes.
DESIGN. Retrospective review of medical records.
SETTING. Diabetes centre of a district hospital, Hong Kong.
PARTICIPANTS. Patients with poorly controlled diabetes referred to a diabetes centre.
MAIN OUTCOME MEASURES. Primary endpoints were mean change in glycated haemoglobin levels and the number of patients who achieved glycated haemoglobin levels of 7.0% or lower, 7.5% or lower, and 8.0% or lower, respectively. Complementary endpoints were serial changes in body weight, blood pressure, and lipids.
RESULTS. One hundred and eighty-five patients, predominantly with type 2 diabetes (94.6%), were reviewed. Median duration since diagnosis of diabetes was 8 years (interquartile range, 4.3-11.8 years). Seventy-three patients had a body mass index of 25 kg/m2 or higher. The baseline and latest glycated haemoglobin levels were 10.4% (standard deviation, 2%) and 8.2% (1.4%), respectively; mean reduction was 2.2% (95% confidence interval, 1.9-2.5; P<0.0005). Eighty-one patients were discharged after a median 32 weeks of follow-up. Their mean glycated haemoglobin level on discharge was 7.5% (0.8%), and the mean reduction was 2.8% (95% confidence interval, 2.4-3.3; P<0.0005). The cumulative percentages of discharged patients who achieved glycated haemoglobin levels of less than 7.0%, 7.5%, and 8.0% were 30.9%, 53.1%, and 77.8%, respectively. Newly diagnosed diabetes (P=0.006) was the only factor which predicted a favourable glycaemic response.
CONCLUSION. The Diabetes Centre provided effective management for a heterogeneous group of patients referred with poorly controlled diabetes.
Key words: Diabetes mellitus; Hemoglobin A, glycosylated; Hong Kong; Program evaluation
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