Benefits Provided by an Integrated Education and Clinical Diabetes Centre: A Follow‐up Study

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Abstract
The effects of a new integrated system of diabetes care with an enhanced role of the diabetes specialist nurse based in a purposed design diabetes centre, on diabetes control, attendance and cancellation rates, and admission for diabetic emergencies have been reviewed. Glycaemic control was examined in: (a) a cohort of 163 insulin‐treated and 47 non‐insulin treated diabetic subjects (age < 65 years) studied prospectively before and 3 years following the introduction of a new system of care; (b) a second cohort of more elderly patients aged greater than 65 years studied for the 3 years after the change over; (c) a cross‐sectional study of the clinic population (n = 700) the year before and 3 years after the changeover; (d) a group of patients attending standard unaltered clinics in the same district (n = 157). Significant and sustained falls in HbA1 were observed in all groups of subjects attending the centre, with the means for those aged less than 65 falling from 11.9 ± 2.3% to 9.9 ± 1.9% and for those aged over 65 from a mean of 11.7 ± 2.0% to 10.3 ± 2.3%, 3 years later. The cross‐sectional study provided similar results with a mean HbA1 of 12.2 ± 3.0% prior to changeover and 10.4 ± 4.4%, 3 years later. Smaller but significant changes were observed in patients continuing to attend the routine clinic (from 12.2 ± 2.3% to 11.3 ± 2.6%) over a similar period. Yearly admission rates for ketoacidosis and hypoglycaemia fell from 44 and 23, to 33 and 5 per annum, respectively. Failed to attend rates prior to changeover were 14% of the total appointments and fell to 5.7% 4 years later. We conclude that improvement in standards of diabetic control can be achieved by close integration of education and clinical management.