GLYCAEMIC CONTROL IN T1D PATIENTS TREATED FROM CLINICAL ONSET IN A VALUE-BASED CARE CENTER VS. PATIENTS TRANSFERRED FROM OTHER CENTERS: THE DIABETER EXPERIENCE
- Dick Mul, Netherlands
- Pim Dekker, Netherlands
- Dick Mul, Netherlands
- Martine De vries, Netherlands
- Theo Sas, Netherlands
- Henk-Jan Aanstoot, Netherlands
- Henk Veeze, Netherlands
Abstract
Background and Aims
DIABETER delivers value-based T1D care resulting in better glycaemic control (vs. the Dutch average) among paediatric patients who were treated at DIABETER from diagnosis onwards (primary patients: 31%). However, 69% of patients received treatment in other clinics before they transferred to DIABETER (secondary patients). Recent studies show tracking of life-time HbA1c values and clinical inertia. We assess if our care model improves glycaemic control of secondary patients or if tracking prevents improvement toward glycaemic levels comparable to the primary patient group.
Methods
HbA1c values extracted from our disease management system Vcare were included for patients treated ≥1 year at DIABETER (n= 2014). Secondary patients were only included if they had received ≥1 year of previous care in another clinic. HbA1c changes, determined cross-sectionally per year from 2006-2018, were analysed descriptively for primary and secondary patients. Three hospitals (H1-3) discontinued T1D care and transferred their T1D patients to DIABETER, allowing study of both ‘en bloc’ and individual patient transfers from >40 other referring centers.
Results
HbA1c levels from primary patients (all age groups) fluctuate around 8.0 % over the years (figure). Secondary patients had higher HbA1c at the time they transferred to DIABETER, but the group gradually improved (over months to years) to HbA1c levels comparable with those of primary patients.
Conclusions
Transition to DIABETER results in improved glycaemic control comparable with our primary patients, showing value in our comprehensive care model which may also overcome tracking in (secondary) patients. Additional studies, including treatment, care methods, use of technology and patient-related factors, are needed.