Implementing Results of Clinical Practice Guideline for Diabetes Treatment in Jomthong Hospital, Chiang Mai

Abstract

Background : There was a high number of diabetic (DM) patients who had uncontrolled blood sugar and treated in Jomthong Hospital. Clinical practice guideline (CPG) was implemented in 2011 to cope this problem.
Objective : To explore the blood sugar control results and DM medication cost after the CPG was implemented in Jomthong Hospital.
Material and method : An analytical study was conducted on the 330 patients treated in DM clinic at Jomthong Hospital who had both HbA1c and FBS blood test during January 2010 - December 2011. The clinical, laboratory data and medication cost were retrospectively reviewed. Data was analyzed by using descriptive statistics. Comparison of glycemic control before (year 2010) and after (year 2011) CPG implementation was analyzed by Chi-square test.
Results : All of the patients had type-2 diabetes with the mean age of 59.3 ± 11.7 years. About two-thirds was female and treated DM for 6-10 years. After CPG implementation, the percentage of patients with good glycemic control (HbA1c ≤7% and FBS ≤130 mg/dl) increased from 27.0% to 39.7% (p<0.001). The poor glycemic control group (HbA1c >7% and FBS >130 mg/dl) dropped from 32.4% to 24.2% (p=0.025). The cost of alpha-glucosidase inhibitor increased 50.6% and thiazolidinedione increased 31.1%. Glibenclamide and metformin prescription decreased 14.7% and 5.4% respectively. The insulin cost was 10.9% lower. There was 2.9% increment of annual medication cost and 10.6 % higher number of patients. 
Conclusion : Implementation of CPG for diabetic treatment in Jomthong Hospital resulted in better glycemic control without consuming higher medication cost.