Early short-term intensive multidisciplinary diabetes care: A ten-year follow-up of outcomes

Objectives: To evaluate the outcome of an early short-term intensive diabetic care program followed by a regular out-patient shared-care education program. Methods: We retrospectively reviewed the medical charts of 196 patients newly diagnosed with type 2 diabetes mellitus (DM) who were admitted to the hospital for intensive multidisciplinary interventions. For comparison, we also enrolled 206 patients with type 2 DM newly diagnosed but not receiving short-term intensive program. Both groups all attended an out-patient shared-care education program for more than one year. Outcome measure included average and standard deviation (SD) of glycated hemoglobin (HbA1c) over ten years, serum creatinine (Cr), lipid profile, urine albumin/ Cr (UACR), and chronic diabetic complications after 10 years later. The Kaplan-Meier event happening rates were used to compare the event rate of two samples. Multivariate Cox proportional-hazards models were used to investigate the influence of different variables on chronic complications. Results: Patients who received short-term intensive diabetic education had less SD of HbA1cs: (0.7 +/- 0.7% vs. 1.0 +/- 0.8% (5.3 +/- 5.3 mmol/mol vs 9.2 +/- 6.4 mmol/mol), p < 0.001), less new-onset coronary heart disease (CHD) (8.2% vs. 13.7%, p = 0.005), lower serum Cr (1.4 +/- 0.7 mg/dL vs. 1.5 +/- 0.9 mg/dL, p = 0.005), less progression of nephropathy was also revealed (13.5% vs. 21.2%, p = 0.009) and lower UACR (4.7 +/- 1.4 mg/g vs. 5.3 +/- 1.0 mg/g, p < 0.001). There were no group differences in age, gender distribution, average HbA1c, lipid profile, and new-onset of neuropathy and retinopathy. The independent predictors of CHD and nephropathy were short-term intensive diabetic education and SD of HbA1cs. Conclusion: Initiation of earlier intensive short-term multidisciplinary interventions in patients with newly diagnosed DM may decrease coronary heart disease and nephropathy. These better outcomes may be related to less fluctuation in blood glucose levels. (C) 2017 Elsevier B.V. All rights reserved.