Context and Aim

The Royal Melbourne Hospital Diabetes Education Service implemented a number of improvement measures for its ambulatory insulin stabilisation program over the last 2 years. We aimed to establish whether a link exists between engagement in our program and improvement in diabetes control.

Methods

A retrospective audit was performed on all referred patients on the program (n=355) throughout 2015 looking at referral reason, discharge reason, engagement and HbA1c before and after participation. The closest available HbA1c within 6 months prior to referral and 6 months after discharge was included. Engagement was defined as ≥1 contact with a Diabetes Educator involving addressing insulin dose management.

Findings

The most frequent documented referral reason was hyperglycaemia n=64 (35%), new commencement of insulin n=35 (19%) and change of insulin/ treatment regimen n=33 (18%). Of the 355 patients, before and after HbA1c were available in 166 patients. In this group there was a statistically significant reduction in HbA1c from 9.6% pre- to 8.5% post-intervention (p <0.001). There was a trend to a greater HbA1c reduction in those who remained engaged [1.2% reduction versus non engaged 0.6% reduction (p = 0.160)]. Patients who remained engaged, had a mean of 3.5 ± 3.8 contacts, with an association between a greater number of contacts and a reduction in HbA1c (Pearson’s r = -0.231, p = 0.003). The most common discharge reason was failing to maintain contact n=76 (40%) while 34 (19%) reached completion.

Conclusion

Patient referral to our program (predominantly for hyperglycaemia) reduced HbA1c and there was a trend indicating a greater HbA1c reduction in those who remain engaged. While there is a high drop-out rate, we conclude that a small number of contacts can return desirable results and improvement measures should be targeted at establishing initial engagement.