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To compare control in the same insulin-requiring type-2 diabetic patients in a clinic before and after the implementation of specialist-supervised care

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine, Johannesburg, 2014 / Objective: To evaluate and compare any differences in control, i.e. HbA1C, total cholesterol, BP and BMI in a single group of Type-2 diabetes patients during two time periods, i.e. before and after specialist-supervised care. In addition, to describe differences in the use of anti-platelet and statin therapy for primary cardiovascular prophylaxis.
Methods: Patients were recruited from the Diabetes Clinic at Chris Hani Baragwanath Academic Hospital (CHBAH) and the audits of two separate time periods were conducted. The first audit recorded standard of care delivered by registrars from January 2005 to December 2007. The second audit recorded care after the introduction of specialist-supervised care from September 2009 to September 2012. The patients were all insulin-requiring and were required to be seen for at least 24 months during both audit periods. The first recorded HbA1C in (i) 2005 and (ii) from September 2009 triggered the inception of a patient’s assessment periods. Data for at least 80% of parameters had to be available for a patient to be included in the audit.
Results: This study showed significant differences using ANCOVA comparing final values for each audit after adjustment for their respective baseline values in respect of HbA1C (p<0.000), SBP (p<0.012) and BMI (p<0.001) after the implementation of an endocrinologist-supervised clinic. The percentage of patients reaching guideline targets, and the use of aspirin and statins, improved as well.
Conclusion: This study showed a difference in the level of care delivered by the endocrinologist-supervised clinic as opposed to one which was led by registrars.
However, other factors may have contributed to the outcomes, most notably that the consultation time with each patient was longer after the introduction of expert supervision in 2009.
Date17 April 2015
CreatorsBhana, Sindeepkumar Amrathal
Source SetsSouth African National ETD Portal
Detected LanguageEnglish

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