An intensive and personalised care planning programme improves clinical outcomes in patients with diabetic retinopathy: a pilot randomised controlled trial

Amudha Aravindhan, Eva K. Fenwick, Ryan Eyn Kidd Man, Aw Ai Tee, Ecosse L. Lamoureux

Abstract

Background: Using a pilot randomised controlled trial (RCT), to assess the short-term effectiveness of a structured diabetic retinopathy (DR)-specific, intensive, and personalised care planning (DR-IPCP) intervention on diabetes control outcomes in Singaporeans with poorly controlled type 2 diabetes.
Methods: Eighteen individuals with mild-moderate DR and poor glycemic control [HbA1c ≥64 mmol/mol (≥8.0%) over two consecutive 6-month readings] were randomized to DR-IPCP (n=9) or usual care (UC, n=9). The intervention included a physician consultation, an initial personalised eye consultation with a experienced diabetes nurse educator, and three behaviour change follow-up calls. HbA1c (primary outcome), lipids and blood pressure were assessed at baseline and three months post-intervention. Participant feedback regarding the DR-IPCP program was collected at three months via a semi-structured telephone interview.
Results: While no significant between-group differences were observed, DR-IPCP participants experienced significant within-group reductions in HbA1c, total cholesterol, and low density lipoprotein at follow-up compared to baseline [7 mmol/mol (−0.8%), −0.64 mmol/L, and −0.66 mmol/L, respectively]. No significant within-group changes in these parameters were observed in the UC group. Following the DR- IPCP intervention, participants reported a clearer understanding of the link between diabetes management; the development and progression of DR.
Conclusions: DR-IPCP provides an effective short-term improvement in diabetes control parameters in DR patients with poor diabetes control. An adequately powered and longitudinal RCT is warranted to assess the clinical, patient-centred and economic potential of this programme in this population.

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