Assessing the optimal timeline for type 2 diabetes patients to achieve glycemic goal when receiving endocrinology specialty care in an ambulatory setting

Abstract

Specific Aims The purpose of the study was to determine the optimal duration of receiving endocrinology specialty care for patients with type 2 diabetes mellitus (T2DM) to achieve their glycemic targets. The study evaluated associations between patient characteristics and care factors with achieving glycemic targets. Methods A retrospective observational study was performed via chart review. Adult T2DM patients who established care at an Academic Medical Center Endocrinology Clinic during 11/1/2017-11/1/2018 were included if they had a baseline and at least one follow-up HbA1c. The primary outcome was percent of patients who achieved their individualized HbA1c goal within 3, 6, 9, or 12 months of establishing care. We estimated the probability of achieving target HbA1c using Kaplan Meier (KM) model. KM models were used to calculate cumulative probability of achieving HbA1c target with number of major clinical interventions, clinic visits and educational visits. Main Results 36.7% of patients met their HbA1c goal at 12 months. The median time to achieve the individualized HbA1c was 310 days (95%CI 287-NA). The median number of major clinical interventions with a 50% probability of achieving HbA1c target was 3 (95%CI 2-3). Probability was achieved with a median number of 5 clinic visits (95%CI 4-NA) and a median number of 2 educational visits (95%CI 1-NA). Conclusions The optimal timeline to achieve HbA1c goal in T2DM patients who receive specialty care is about one year. The probability of achieving target HbA1c is optimal with 3 major therapeutic interventions, 5 clinic visits, or 2 educational visits.