engleski

Problematic continuity of care for diabetic patients in family medicine – can education of patients help?

Background: Approximately half of the patients with type 2 diabetes mellitus (T2DM) in Croatia had been diagnosed of which only half have a controlled disease. Annual HbA1c measurements are missing in many patients leading to more T2DM complications and unnecessary costs. Research questions: Can individual education of T2DM patients about regular check-ups (including lab findings and physical exams) help achieve better T2DM disease control? Method: This observational intervention study was started in November 2021 in one family practice in Zagreb, Croatia, with 1745 patients (116 have T2DM, 6.65%). HbA1c levels were missing in 46 patients in 2021 who were later called and referred to the lab. All patients who did their lab exam (36, 78.26%) were educated about the importance of regular check-ups in 3-6 months depending on HbA1c. Other patients with T2DM were not called and educated about this matter. All patients with T2DM were checked for having lab parameters and body mass index (BMI) noted in 2022 as the outcome of this intervention. Statistical significance was determined by the Mann-Whitney U test in Statistica v.12.0. Results: 43 T2DM patients had lab results in 2022 (37.07%). 14 were from the educated group (38.89%) and had significantly higher BMI (median 36.10 vs. 29.40 kg/m2, p<0.001) and lower HbA1c (median 7.00 vs. 7.45%, p<0.01) than other 22 patients missing these values in 2022. 29 patients from the second group (41.43%) showed similar results in HbA1c (6.50 vs. 6.90%, p<0.05). The educated group had worse initial HbA1c levels than the second group (7.45 vs. 6.70%, p<0.001) which was significantly improved in 2022 (7.45 vs. 7.00%, p<0.01). Conclusions: Individual education of T2DM patients about the importance of regular lab and physical check-ups in this study was not successful as expected. Better control of T2DM was achieved, although only 1/3 of educated patients had their lab findings noted. Points for discussion: How much do your patients with type 2 diabetes really know about their disease and when should they report for regular check-ups? Are check-ups of patients with type 2 diabetes really necessary every 3-6 months, or we can be satisfied if we manage to examine all patients within one year?

diabetes mellitus, education, quality of care

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