"Stay on top of your diabetes": A better way to control your diabetes?

Background and aims: The Region of North Denmark (RND) has been facing difficulties with high levels of long-term blood sugar levels (HbA1c) for several years. In 2019 a new quality strategy was developed by Steno Diabetes Center North Denmark (SDCN) and implemented in 2020 at Department of Endocrinology, Aalborg University Hospital. The new strategy contains a fast-track program "Stay on Top of Your Diabetes" which aims to help patients with poor glycemic control (≥70 mmol/mol). The program offers a personalized 12-month fast-track program where the patients are undergoing a tighter follow-up by a doctor and nurse.

Materials and methods: Patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) with poor glycemic control were included in the program during a two-year period from January 2021 to March 2023 if they fulfill following criteria: poor glycemic control for more than the last three visits at the hospital, not being on a waiting list for receiving any kind of diabetes technology and referral to this program from an endocrinologist based on a clinical assessment. The patients were seen every three months during the program period at the Department of Endocrinology and a HbA1c was collected at every visit. A paired t-test was performed to analyze the differences in HbA1c from baseline to program outcome. To assess the program from the patient’s perspective a satisfaction questionnaire was distributed after the 12-month follow-up.

Results: 138 patients were enrolled in "Stay on Top of Your Diabetes" (93 with T1D and 42 with T2D). The calculated difference in change for HbA1c from baseline to program outcome for T1D was -6.82 mmol/mol (95% CI: -1.67 to -11.98 mmol/mol; p=0,0105) and for T2D -14.43 mmol/mol (95% CI: -7.99 to 20.87mmol/mol; p<0,0001). A questionnaire was distributed to 81 out of 138 patients who had a Danish digital mailbox (e-Boks) where 53 out of 81 patients (65,4%) responded to the questionnaire.

Conclusion: This study indicates that patients have strong significant benefits from participating in the program based on the decreased HbA1c and that it supports patients to achieve better glycemic control. The satisfaction questionnaire reveals that the patients are extremely satisfied with the program and score highly on all questions. However, it is important to address that this study was performed in a daily clinical setting and was not randomized or further adjusted which means that the interpretation of the results should be done carefully. The results could be further investigated by adding a control group or adjusting variables for sex, age, and diabetes duration.