Relationship of the Continuity of Care and Glycemic Control in Outpatients with Type 2 Diabetes Mellitus- A Five Year Longitudinal Analysis

ABSTRACT

Objective: Continuity of care has demonstrated positive outcomes from the advanced countries with insurance care model. There is limited evidence for the benefits from developing countries, in limited resource setting where the patients directly pay from the pocket for the diabetes care. Methods: We retrospectively analysed the relationship between the continuity of care and the glycemic control in patients who atleast had a biannual visit to our comprehensive care centre from 2016 to 2020 (n=1160). Results: The mean number of visits in the year 2016, 2017, 2018, 2019 and 2020 were 3.6 (±1.6, max 11, 95% CI 3.38 to 3.98), 5 (±2.5, max 16, 95% CI 4.5 to 5.5), 4.8 (±2.1, max 12, 95% CI 4.4 to 5.2), 4.7 (±2.2, max 14, 95% CI 4.3 to 5.1), 3.4 (±1.6, max 12, 95% CI 3 to 3.7) (p< 0.0001), respectively. The mean number of visits cumulatively for the continuous five years for each patient was 22 (±7.9, min 11, max 56, 95% CI 20 to 23). The mean number of HbA1c readings done cumulatively for the continuous five years for each patient was 22 (±3.8, min 1, max 17, 95% CI 3.3 to 4.4). The mean interval (days) between the two consecutive visits was 85 (±26, min 33, max 155, 95% CI 81 to 90). The mean number of HbA1c tests were 3.8 (±2.8, min 1, max 17, 95% CI 3.3 to 4.4). The mean number of visits were 4.3 (±1.6, min 2.2, max 11, 95% CI 4 to 4.6). There was a non-significant positive correlation between the mean number of visits and the mean HbA1c readings (Pearson r 0.113, p= 0.22). The baseline value of HbA1c (%) was 8.0 (±1.5, min 5.3, max 13.3, 95% CI 7.7 to 8.3), which reduced by 0.7 when compared for the minimum value of HbA1c achieved at any point of time as mean 7.2 (±7.2, min 4.8, max 10.9, 95% CI 7 to 7.5), (p< 0.0001). There were 360 patients who had atleast one visit in 3 months and achieved HbA1c < 7, as compared to 250 patients with more than 3 months interval for consecutive visits and with HbA1c ≥ 7 (p=0.0404, OR 1.2 95% CI 1.01 to 1.62). COVID-19 induced lockdown led to the decrease in the patient visits in the year 2020. There were 55 all cause hospitalizations. Discussion/Conclusion: The results of our study demonstrate that comprehensive diabetes care have a potential positive implication, even in out-of-pocket ecosystem, which can drive the demand for a continuous follow up visits. We attribute long continuity of care for the smaller number of hospitalizations.