DDE-xperience: three-year evaluation of patient experiences and clinical outcomes from a dietitian-diabetes educator led model of care for insulin dose adjustment in a renal outpatient clinic
Stacey Sharp1, Michelle Palmer1, Emma Owers1 1Logan Hospital, Meadowbrook , Qld , Australia
Abstract
Background: Diabetes is the most common cause of chronic kidney disease (CKD). Medical management in this population is challenging given limited medication choices, hypoglycaemia risk, complex dietary management, poor health literacy and socioeconomic status. Innovative models of care are needed to appropriately manage diabetes in CKD. We aimed to evaluate patient experience and clinical outcomes of adult patients with diabetes in our novel dietitian-diabetes educator (DDE) led insulin dose adjustment service within a renal outpatient clinic.
Method: Blood glucose levels (BGLs), HbA1c, hypoglycaemic events, change in nutrition diagnoses, occasions of service (OOS) from medical charts pre- and post-DDE intervention and patient experience collected via phone calls for patients referred by nephrologists for insulin titration between 2020 and 2022. Patients with cognitive impairment, hearing difficulties and inability to regularly test BGLs were excluded. Data was analyzed using descriptive statistics and paired samples t-tests.
Results: Seventy-two patients were eligible, with 72% completing experiential surveys (n=52, 42% female, 58% aged 36-65yrs, 6% Indigenous). Average HbA1c’s were 8.80±1.80% pre-treatment and 7.95±1.74% post-treatment (n=37, p=0.005). Of patients with hypoglycaemia (n=19), weekly number of hypoglycaemia episodes reduced from 1.5(1-8) to 0(0-2) (p<0.001). Most (76%) patients had resolution of their nutrition diagnosis. Average OOS were 7 (range: 2-21) in 2021-2022. Mean net-positive promoter score on patient experience surveys was 93%. One adverse event was reported (hypoglycaemia admission) due to the patient deviating from recommendations. Discussion: This innovative DDE service shows improved clinical outcomes, minimal adverse events, timely care, and high patient satisfaction in a high-risk population.
Biography
Stacey has worked as Clinical Dietitian for 15 years and gained her grad cert in diabetes education in 2013. Her main area in expertise has been in chronic disease and is passionate about providing models of care that provide the best experience for the patients.