Browsing Masters Dissertations by Authors
The effectiveness of telephone consultation in the management of patients with diabetes mellitusMellor, Duane; Joseph, Philippa (University of ChesterClatterbridge Hospital, 2013-09)Achieving optimal glycaemic control is a key clinical objective in diabetes management. The maintenance of near normal blood glucose levels is considered crucial in the prevention of the microvascular and macrovascular complications of diabetes mellitus (DM). Telephone support can be an integral part of good diabetes care and patients requiring such support are contacted by the Diabetes Specialist Nurse (DSN). These calls are time consuming and the effectiveness of this service had not been evaluated previously. The research question asked - Does telephone consultation with the DSN improve glycaemic control? - A review of telephone contacts over two months and subsequent follow up for six months and is there a relationship between the number and frequency of follow up consultations and improvement in glycaemic control? A retrospective review of the local diabetes data base was performed to review patients who had received DSN telephone calls for poor glycaemic control. Patients were identified from weekly phone call lists in September and October 2012. The following data was collected and analysed: glycosylated haemoglobin A1c (Hba1c), weight, alterations to insulin dose and oral agents, number of calls per patient and the time period the calls were made over at baseline and six months following telephone contact. Data is reported as median with range, unless otherwise stated. 108 patients were called over the two month period. Of the 108 patients 56 (51.9%) were male and 52 (48.1%) were female. The mean age for males was 63.1±14.2 years and for females was 63.6±13.9years. 26 patients (24.1%) had type 1diabetes (T1DM) diabetes and 82 patients (75.9%) had type 2 diabetes (T2DM). Each patient had a median of five calls (range 1-27 calls) over a median of 13 weeks (range 1-26 weeks). Nine patients were on oral hypoglycaemic agents (OHAs) only and 99 patients were on either insulin therapy alone or a combination of insulin and OHAs. HbA1c significantly improved from 78 (43-140) to 72 (41-132) mmol/mol (9.3 [6.1-15] to 8.7 [5.9-14.2]%) at six months, p=0.0001, for those patients on insulin, (analysed using Wilcoxon test), however there was no significant improvement in HbA1c p=0.400, for those patients on OHA’s only. DSN telephone support to patients approximately every eighteen days over thirteen weeks significantly improved HbA1c at six month follow up. Longer follow up is required to determine if this reduction is sustained.