Impact of an integrated care program on glycemic control and cardiovascular risk factors in patients with type 2 diabetes in Saudi Arabia: an interventional parallel-group controlled study.

BACKGROUND: Long intervals between patient visits and limited time with patients can result in clinical inertia and suboptimal achievement of treatment goals. These obstacles can be improved with a multidisciplinary care program. The present study aimed to assess the impact of such a program on glycemic control and cardiovascular risk factors. METHODS: In a randomized, parallel-group trial, we assigned 263 patients with poorly controlled type 2 diabetes mellitus (T2DM) to either a control group, standard care program, or a multidisciplinary care program involving a senior family physician, clinical pharmacy specialist, dietician, diabetic educator, health educator, and social worker. The participants were followed for a median of 10 months, between September 2013 and September 2014. Glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profiles, and blood pressure (BP) were measured. The assignment was blinded for the assessors of the study outcomes. The study registry number is. RESULTS: In the intervention group, there were statistically significant (p < 0.05) post-intervention (relative) reductions in the levels of HbA1c (-27.1%, 95% CI = -28.9%, -25.3%), FBG (-17.10%, 95% CI = -23.3%, -10.9%), total cholesterol (-9.93%, 95% CI = -12.7%, -7.9%), LDL cholesterol (-11.4%, 95% CI = -19.4%, -3.5%), systolic BP (-1.5%, 95% CI = -2.9%, -0.03%), and diastolic BP (-3.4%, 95% CI = -5.2%, -1.7%). There was a significant decrease in the number of patients with a HbA1c ≥10 (86 mmol/mol) from 167 patients at enrollment to 11 patients after intervention (p < 0.001). However, the intervention group experienced a statistically significant increase in body weight (3.7%, 95% CI = 2.9%, 4.5%). In the control group, no statistically significant changes were noticed in different outcomes with the exception of total cholesterol (-4.10%, p = 0.07). In the linear regression model, the intervention and the total number of clinic visits predicted HbA1c improvement. CONCLUSIONS: Implementation of a patient-specific integrated care program involving a multidisciplinary team approach, frequent clinic visits, and intensified insulin treatment was associated with marked improvement in glycemic control and cardiovascular risk factors of poorly controlled T2DM patients in a safe and reproducible manner. TRIAL REGISTRATION: ISRCTN Identifier: ISRCTN83437562 September 19, 2016 Retrospectively registered.

Microvascular and macrovascular complications of type 2 diabetic mellitus in Central, Kingdom of Saudi Arabia.

OBJECTIVES: To determine the prevalence of macrovascular and microvascular complications of type 2 diabetes mellitus and its associated determinants.  Methods: We evaluated the online medical records of patients with type 2 diabetes mellitus who have been seen in chronic disease unit between April and June 2014. Seven hundred and forty-eight participants satisfied the inclusion criteria. Of these, 317 (42.4%) were males with a mean age of 57.9 years, 681 (64.3%) were obese with body mass index (BMI) of greater than 30, while only 9.6% had normal BMI (less than 25).  Results: Only 158 (21.1%) had controlled hemoglobin A1c level. Retinopathy prevalence was 14.8% and neuropathy was 5.6%. Macrovascular complications accounted for 12.1%. Patients' age and duration of diabetes were main predictors of developing complications. Patients with more than 20 years  history of diabetes have 30% more odds of developing the complications when compared to patients with less than 10 years of diabetes history. Each increment in age by one year increases the odds of developing microvascular complications by 4% and macro vascular complication by 2%.  Conclusion: Our results showed diabetic patients with poor glycemic control, and longer duration of diabetic history had higher prevalence of both macrovascular and microvascular.