Effectiveness of Triangular Model Approach in Rural Diabetic Patients

To study the role of teamwork in achieving glycemic control in rural patients using a cost-effective triangular model.

Methods:

Of the 200 selected diabetic patients 60 subjects were eligible for the study. Inclusion criteria: 1) Age: men and women between age group 20 years to 70 years. 2) known Type 2 Diabetes mellitus, 4) HbA1c 7 to 10 %. Exclusion criteria: Type 1 diabetes mellitus, Pre-existing renal, hepatic or cardiac disease, Hba1c > 10 %.

Results:

60 patients were randomly divided into two groups i.e. group A and B which comprised of 30 patients each. Patients were evaluated at the start of study and were followed up at 3, 6 months with measurement of FBS, PPBS, HbA1c and lipid profile.

A triad was established between our center, health worker, and diabetes educator. Group A 30 patients were monitored on daily basis with the help of Health Worker for proper diet intake, regular intake of OHA without skipping of a single dose in entire 6 months duration whereas the Group B were monitored on Day 1 and these patient of Group B were explained the about the drug dosage, frequency of drug intake, with complete diet explanation and Life style modification, these both groups were followed on monthly basis in OPD clinic for review. In Group A there were 20 males (66.7%) and 10 females (33.3%) compared to Group B (males 17 (56.7 %) and females 13 (43.3%) P value = 0.426, chi square 0.635.

On first follow up after 3 months it was observed that the mean FBS, PPBS were significantly low in the group of patients who had regular follow up p<0.05. HbA1c was lower in patients who had regular follow up but the decrease was not found to be statistically significant p>0.05.

At 6 months it was observed that mean FBS, PPBS, HbA1c, total cholesterol, TGL, and LDL was significantly low in the group of patients who had regular follow up p < 0.05. There was no statistically significant difference in the mean HDL levels between groups.

Discussion/Conclusion:

Adherence to therapies is a primary factor that determines the success of therapy and decreases the negative consequences not only for the patient but also for the health care provider. A single contact with physician could not achieve good glycemic control as seen in group B when compared to a systematic approach and close monitoring that increased the adherence to medication and diet as demonstrated in group A.