Building the evidence for integrated care for adults with Type 2 Diabetes: A Pilot Study  — ASN Events
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Building the evidence for integrated care for adults with Type 2 Diabetes: A Pilot Study  (#376)

Jessica L Browne 1 2 , Jane Speight 1 2 , Carina Martin 3 , Chris Gilfillan 4
  1. The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
  2. School of Psychology, Deakin University, Geelong, VIC, Australia
  3. Carrington Health, Box Hill, Melbourne, Victoria, Australia
  4. Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia

Introduction:  The Integrated Diabetes Education and Assessment Service (IDEAS) is a multidisciplinary, community-based service in Melbourne for adults with type 2 diabetes (T2DM) referred by their primary care provider, or discharged from hospital inpatient or ambulatory services. Our aim was to assess the psychosocial and biomedical outcomes of adults with T2DM attending IDEAS relative to hospital-based outpatient diabetes clinics.

Methods: Two pilot evaluations were conducted: 1) six-month pilot randomised controlled trial (RCT; N=56), and 2) cross-sectional study of existing patients of the two services (N=92). The primary outcome was diabetes distress (assessed using the Problem Areas In Diabetes scale); secondary outcomes were perceived quality of diabetes care (Patient Evaluation of the Quality of Diabetes care), diabetes-specific self-efficacy (Diabetes Empowerment Scale – Short Form), and HbA1c. Inclusion criteria were: diagnosed with T2DM; aged ≥18 years; English-speaking; new referrals (RCT) or had attended the service at least twice (cross-sectional study).

Results: In respect of diabetes distress, there was a non-significant trend in favour of IDEAS in both studies. Diabetes-specific self-efficacy did not differ between settings but perceptions of quality of care favoured IDEAS (p=0.01). In the RCT, HbA1c improved significantly overall (both settings p<0.05) but there was no effect of service setting. In the cross-sectional study, HbA1c was equivalent between settings. 

Conclusions: Differences in diabetes distress between service settings did not reach statistical significance but the studies were likely underpowered to detect differences. Patients’ evaluations of the quality of diabetes care at IDEAS are very positive, which is likely to be one of the key strengths of the model. Importantly, this positive patient experience is not at the expense of glycaemic efficacy. The IDEAS model holds promise for people with T2DM who need more specialist/multidisciplinary care than can be provided in primary care.