determining criteria for inpatient diabetes consultation

Table 1Utility differences from the time trade-off survey

Basal only Basalebolus

n Utility CI95L CI95H n Utility CI95L CI95H

Population1 Flex vs. 1 Fixed 1121 0.016 0.011 0.022 1144 0.013 0.007 0.0201 Fixed vs. 2 Fixed 1121 0.039 0.032 0.046 1144 0.022 0.016 0.0281 Flex vs. 2 Fixed 1121 0.055 0.048 0.063 1144 0.036 0.029 0.043Diabetes populations*

1 Flex vs. 1 Fixed 192 0.015 0.004 0.027 465 0.004 e0.006 0.0141 Fixed vs. 2 Fixed 192 0.042 0.025 0.061 465 0.021 0.013 0.0311 Flex vs. 2 Fixed 192 0.057 0.040 0.076 465 0.025 0.015 0.035

CI95L, confidence interval 95% (low); CI95H, confidence interval 95% (high).* Diabetes population with basal-only questions: 192 patients with type 2 diabetes; diabetes population with basalebolus questions: 265 patients with type 1 diabetes; 200patients with type 2 diabetes.

Abstracts / Can J Diabetes 37 (2013) S13eS84 S39

respondents with diabetes. Flexible dosing and fewer injectionshave a positive HRQoL impact, which may enhance therapyadherence and potentially contribute to improved long-termoutcomes. The impact of flexibility is greater in people treatedwith basal-only insulin regimens, and diminishes if bolus in-jections are part of the treatment regimen.

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Evaluating the Management of Type 2 Diabetes in the PrimaryCare Setting Through a Novel Multi-Step Needs AssessmentProcessKEITH BOWERING*, STEWART HARRIS, LAWRENCE A. LEITER,VINCENT WOO, JEAN-FRANÇOIS YALEEdmonton, AB; London, ON; Toronto, ON; Winnipeg, MB; Montreal,QC

Objective: To uncover real-life gaps in treating type 2 diabetes(T2DM) in primary care.Methods: Between January and October 2012, primary care prac-titioners (PCPs) were invited to participate in a needs assessmentconsisting of: 1) online questionnaires assessing participants’perception of T2DM practice; 2) focus group sessions to discussquestionnaire findings; 3) electronic submission of treated T2DMpatients’ profiles with follow ups at 2 subsequent visits to assessactual practice.Results: One hundred fifty-seven participating PCPs submitted1459 baseline visits, 1016 follow-up visits #1 and 977 follow-upvisits #2 profiles. At baseline, 43% of 1459 patients were not atA1C target of �7.0%; 33% of these patients were on monotherapy.By the end of assessment, 63% of the 691 patients with knownA1C at follow-up visit #2 had A1C �7.0%, including 37% of the345 patients not at A1C target at baseline followed for 2 subse-quent visits. Only 7% of the 258 patients not meeting targets atfollow-up visit #2 were on monotherapy. Subsequently, casesrepresenting the most common challenges identified were inte-grated in several educational programs, designed to generatediscussion on challenges in real practice settings and promotechanges in managing T2DM patients to overcome identifiedpractice gaps.Discussion: While there was a trend to add antihyperglycemicmedication leading to subsequent improvement in A1C, there arestill many challenges associated with therapeutic inertia andachieving A1C targets in primary care. This initiative demonstratesa novel needs assessment technique, with tailoring of aneducational program based on identified real-life gaps in diabetesmanagement.

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Determining Criteria for Inpatient Diabetes ConsultationHEATHER A. LOCHNAN*, DIANA N. JASKOLKAOttawa, ON

Introduction: A diabetes team consultation is considered usefulto improve glycemic control in hospitalized patients, yet man-agement of “routine” diabetes care by the endocrinologyconsultation service can lead to caregiver frustration and fa-tigue. A mechanism to ensure limited resources are directedwhere most needed would be beneficial. No criteria exist thatdescribe which patients are likely to benefit most from diabetesteam consults.Objective: Develop consensus criteria among diabetes experts, todetermine which clinical scenarios should be prioritized forendocrinology or diabetes nurse consultation.Methods: A modified Delphi process allowed the local “diabetesexperts” to indicate which of 60 clinical scenarios would benefitfrom consultation by an endocrinologist, diabetes nurse or both.-Those with low inter-rater correlation were discarded theremaining were then ranked by the experts for their priority.Triangulation was done through member checking withparticipants.Results: Forty clinical scenarios had good inter-rater correlationand were then ranked. A consult with an endocrinologist wasdeemed absolutely necessary in 16 clinical situations including forpatients who are newly diagnosed with DM-1 admitted with DKAor hyperglycemia, patients on TPN with blood glucose >15.0 mmol/L,and patients with a feeding tube and blood glucose >15.0 mmol/L.Chart audits reveal these patients made up only a small percentageof cases being seen and suggest case finding might be required.Conclusion: Consensus criteria for endocrinology consultationwere established among diabetes expert using a systematicapproach. Criteria for consultation can encourage rational resourcemanagement and be used for case finding.

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Effectiveness of Liraglutide in Type 2 Diabetes PatientsSwitched from a DPP-4 Inhibitor: 1-Year Data from EVIDENCE�GUILLAUME CHARPENTIER, LUC MARTINEZ, EVELINE ESCHWEGE,SULIYA MADANI*, ALFRED PENFORNIS, PIERRE GOURDY,JEAN-FRANÇOIS GAUTIERCorbeil Essonnes, France; Paris, France; Villejuif, France; Besançon,France; Toulouse, France

Here we assess the effectiveness of 1 year’s treatment withliraglutide in patients with type 2 diabetes who switched from aDPP-4 inhibitor (DPP-4i) in EVIDENCE� study; a multicentre,