Abstract

Background: Structured and regular review of patients with diabetes has shown to be effective in improving the process of their care. However, a register-recall system that periodically identifies patients not meeting their treatment targets and actively recalls them for review is not widely implemented in Saudi primary care clinics. Objectives: To examine whether using a register-recall system in a primary care setting will result in improvement in glycemic control among patients with poorly controlled diabetes.
Materials and Methods: In this open-labeled prospective trial, two out of eleven primary care clinics at King Abdul-Aziz housing city, with closely matched demographics, were identified and cluster-randomized to receive intervention (register-recall) versus control (routine care) during the month of August 2015. One hundred and twenty eight patients with uncontrolled diabetes (glycated hemoglobin [A1c] ≥ 7.5%) were identified in both clinics and patients  were then followed up for 6 months. A1c, blood pressure (BP), and low-density lipoprotein (LDL) were noted at baseline, 3 months and the end of the trial.
Results: Modest improvements in glycemic control were achieved among the intervention group at 6 months (mean difference [MD] = −0.44, 95% confidence interval [CI] = −1.06-0.18, P = 0.16). The odds of having uncontrolled diabetes (A1c ≥ 7.5%) among the intervention group was less than the control group (odds ratio [OR] = 0.24,  95% CI = 0.03-2.19, P  =  0.37).  Significant  improvement  in  systolic  blood  pressure  (SBP)  (MD = −7,  95%  CI=  −12.7  to −1.3, P = 0.015) was noted at 6 months, while changes in LDL levels were marginal (MD = 0.1, 95% CI = −0.23- 0.43, P = 0.55). Except for SBP, none of the observed results quite reached statistical significance. Conclusion: Modest, statistically insignificant, glycemic improvements were observed in this trial, while significant SBP improvement was achieved. The role of register-recall is unclear when dealing with very poorly controlled disease (A1c ≥ 10.5%).