Temporal HbA1c patterns amongst patients with type 2 diabetes referred for specialist care: Data from the S4S-DINGO-Diabetes Informatics Group.
OBJECTIVE
To evaluate the achievement of HbA1c targets in patients with type 2 diabetes mellitus in specialist practice.


METHODS
This audit was undertaken by members of the S4S Diabetes Informatics Group (DINGO), a consortium of Australian endocrinologists in private practice who contribute de-identified data from their electronic medical record, Audit 4 (Software 4 Specialists, S4S, Australia & New Zealand) for audit purposes. Data from patients with type 2 diabetes was extracted. Inclusion criteria were: initial age<70years, baseline HbA1c>7% (53mmol/mol), with at least another HbA1c recorded in the next 2years, and a minimum of 2years follow-up. Data was analysed using a linear mixed effects model.


RESULTS
Of the 4796 patients in the dataset with type 2 diabetes mellitus, 1379 patients fulfilled inclusion criteria. The median age at initial consultation was 57 (49-64)years. The median baseline HbA1c was 8.7 (7.8-9.8)% (72mmol/mol). There was a 1.0% reduction in HbA1c to 7.7 (7.1-8.6)% (61mmol/mol) (p<0.0001) in the first 3-6months following referral, after which there were no further changes. The initial reduction was maintained with minimal loss of control at 4years. By 3-6months, 24% of patients achieved the target HbA1c.


CONCLUSIONS
Referral of patients with type 2 diabetes to an endocrinologist reduces HbA1c, and the effect is sustained over the medium term; however only a minority of patients reach targets.
Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia. Electronic address: Teresa.Lam@almedical.com.au.
Teresa
T
Lam
Software 4 Specialists, Sydney, Australia.
David M
DM
Hoffman
Geelong Endocrinology and Diabetes, Geelong, Victoria, Australia.
Kimberly
K
Cukier
Hills Street Consulting Rooms, 55 Hills Street, Gosford, Australia.
David
D
Darnell
Department of Endocrinology, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; Garvan Institute of Medical Research, Sydney, Australia.
Jerry R
JR
Greenfield
Geelong Endocrinology and Diabetes, Geelong, Victoria, Australia.
Natalie
N
Harrison
Western Sydney Diabetes and Endocrine Centre, Sydney, Australia.
Tien-Ming
TM
Hng
Mona Vale Hospital, Coronation Street, Mona Vale, NSW, Australia.
Anthony F
AF
Morrow
Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
N Wah
NW
Cheung
D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged
D006442:Glycated Hemoglobin
Diabetes; Glycaemic control; HbA1c; Private practice