Impact of integrated care program on glycemic control and cardiovascular risk in adult patients with type 2 diabetes

Objective: To evaluate the impact of a multidisciplinary care program for patients with uncontrolled type 2 diabetes (T2D). • Methods: We conducted a before-and-after study among patients with uncontrolled T2D and/or comorbidities at a primary care center in Riyadh, Saudi Arabia. The intervention consisted of intensified and patient-specific multidisciplinary care. The team included a senior family physician, nurse, clinical pharmacist specialist, dietician, diabetic educator, health educator, and social worker. Outcomes measured were HbA1c, fasting blood glucose (FBG), lipid profile, and blood pressure (BP). • Results: A total of 41 patients were included in the study. Mean age was 56.2 years. HbA1c, FBG, triglycerides, and total cholesterol were significantly reduced in the post-intervention stage (reductions of 18.5%, 21.0%, 16.0%, and 10.5%, respectively). The reduction in HbA1c was highest among patients with uncontrolled diabetes without comorbidity (25.7%), moderate among patients with cardiovascular disease and/or dyslipidemia (12.6%) and minimal among those with renal problems (0.3%, p < 0.05). LDL cholesterol was also reduced (10.5%, but not significantly). HDL cholesterol and BP did not show any significant changes in the postintervention stage. • Conclusion: Integrated care was associated with a 20% improvement in glycemic control and up to a 16% reduction in serum lipids but no change in blood pressure among patients with T2D at high risk of cardiovascular disease.