A CLINICAL AUDIT ON DIABETES CARE IN A MULTIDISCIPLINARY-TEAM DIABETES CLINIC

Abstract

INTRODUCTION
The implementation of a Diabetes Multidisciplinary-team Clinic (DMTC) is a step taken to help more patients achieve their glycemic goal. In 2018, Kajang Hospital Endocrine Unit has set up a team consisting of doctors, diabetes educators, pharmacists and dietitians to provide a unique and optimum care for every person with diabetes seen.

METHODOLOGY
We randomly audited patients referred to DMTC in 2018. The diabetes care components were audited before (baseline) and after (4 and 8 months) the implementation of DMTC. Data were compared against local guidelines to achieve target HBA1c, blood pressure (BP), and lowdensity lipoprotein-cholesterol (LDL-C). We described demographics of the patients and compared the mean difference in target goals between visits.

RESULTS
There were 100 patients recruited in this study. The mean age was 51±2.2 years old, where 60% of the patients were more than 50 years old. Most patients were female (59%). 54% were Malay while 33% were Indians. Chinese and other races constitute 11% and 2%, respectively. We observed a significant reduction in HbA1c compared to baseline levels after 8 months (10.4±2.5 vs 9.9±2.5%; p=0.001). Patients had significantly improved mean systolic BP after 8 months from baseline (139.47±18.6 mmHg vs 135.12±14.6 mmHg; p=0.003), but not the diastolic BP (80.34±12.6 mmHg vs 77.77±10.5 mmHg; p=0.183). The LDL-C levels, however, did not improve from baseline and the percentage of achieving target LDL-C levels were not any better after 4 and 8 months of follow up.

CONCLUSION
The results of this audit were generally positive and emphasized the feasibility of improving the current clinical practice. Further effort and more structured approach are needed to identify the treatment gaps between the current practice and target goal.