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Mahmood El-Gasim, Razia Amin, Shehab Al-Abed, adam mapani, Omar Abdul Rahman Mahroo, Declan Flanagan, Catherine A Egan; Changes in glycated hemoglobin levels following consultation with diabetes specialist nurse in retinal clinics. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2897.
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Improved glycemic control is associated with reduced risk of microvascular complications including sight-threatening diabetic retinopathy. We explored whether a reduction in glycated hemoglobin levels (HbA1c) was discernible following consultation with a diabetes specialist nurse who was present in clinics in the retinal service of Moorfields Eye Hospital.
As an initiative to assist patients in our service with their glycemic control, a diabetes specialist nurse was employed to be present in retinal clinics. Patients are offered the opportunity of a consultation. HbA1c levels are measured and recorded electronically. The database was retrospectively searched over an 18-month period. Patients seen on more than one occasion were included, with HbA1c levels compared between first and second visit (paired t test). Patients were excluded if the interval was less than 3 months. Readings measuring “ >130 mmol/mol” were taken as 130 mmol/mol for analysis.
166 patients met the inclusion criteria. 35% were female. Mean (SD) age was 55 (11) years. Thirteen patients (8%) had type 1 diabetes. Mean (SD) interval between visits was 8 (4) months (median 7; range 3-20 months). Mean HbA1c levels were 87.0 and 78.2 mmol/mol for first and second visits respectively (p<0.0001). Medians were 84.7 and 73.8 mmol/mol respectively. Mean change was -8.8 mmol/mol (95% CI -5.8 to -11.7 mmol/mol). When patients were grouped by interval between visits, mean changes were -7.3, -8.0 and -14.5 mmol/mol for intervals of 3-6 months, 7-12 months and >12 months respectively; all were statistically significant (p<0.01).
A significant mean reduction in glycated hemoglobin of 8.8 mmol/mol was seen. Although limited by lack of control data, and a likely selection bias towards patients with poor glycemic control, the findings are consistent with a beneficial effect of the intervention, similar to published data from more intensive educational interventions in diabetes. The effect appears to be sustained, with greater reductions after longer follow up intervals. As ophthalmologist time is limited in busy retinal clinics, the availability of a specialist nurse who can address lifestyle factors in selected patients can potentially reduce long-term risk of sight-threatening retinopathy and other complications, with likely improved quality of life and reduced healthcare costs.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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