Impact of a Rapid Optimization Clinic on Glycemic Control and Insulin Deintensification in Patients With Diabetes: An Early Retrospective Audit
https://doi.org/10.15605/jafes.041.S1
- Author:
Pang Hoy Yan
1
;
Varuna Shashti Dhevi Marimuthu
1
;
Amir Ridzwan Maula Mohd Nasir
1
;
Muhammad Firdaus Ghani
1
;
Chen Chiew Yee
1
;
Hidayatil Alimi Keya Nordin
1
;
Elliyyin Katiman
1
Author Information
1. Endocrinology Unit, Tengku Permaisuri Norashikin (Kajang) Hospital
- Publication Type:Journal Article
- MeSH:
Humans;
Glycemic Control;
Retrospective Studies;
Diabetes Mellitus;
Insulins
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):41-42
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Improving glycemic control while minimizing unnecessary
insulin exposure is an important goal in diabetes
management. The Rapid Optimization Clinic (ROC) was
established as a structured multidisciplinary service to
support therapy individualization, close follow-up, and
timely insulin deintensification. This audit evaluated early
changes in glycated hemoglobin A1c (HbA1c) and insulin
treatment burden following ROC care over 3 months.
Methodology:We conducted a retrospective audit of routine clinical
data from patients with diabetes managed in the ROC at a
district hospital. Baseline and 3-month HbA1c and insulin
data were extracted from non-electronic clinic records.
Insulin dose was standardized as total daily dose (TDD)
in units/kg/day. Insulin deintensification was evaluated
primarily by change in TDD from baseline to 3 months and
by the proportion of patients who discontinued insulin
during follow-up. Paired analyses were performed for patients with complete baseline and follow-up data for
each outcome. Continuous variables are presented as mean
± standard deviation or median with interquartile range,
as appropriate. Exploratory analyses were undertaken to
assess whether available patient factors were associated
with HbA1c improvement.
Results:Twenty-three patients were included. Paired HbA1c data
were available for 12 patients, whereas paired TDD data
were available for 21 patients. Mean HbA1c decreased
from 10.78 ± 2.59% at baseline to 8.42 ± 2.29% at 3 months,
representing a mean reduction of 2.36 percentage points
(95% confidence interval [CI] 0.09–4.62; p = 0.043). Mean TDD
decreased from 0.434 ± 0.248 to 0.286 ± 0.313 units/kg/day,
corresponding to a mean reduction of 0.148 units/kg/day
(95% CI 0.077–0.219; p <0.001). Insulin was discontinued in
9 of 21 patients (42.9%). No clear association was observed
between HbA1c improvement and age, sex, or number of
visits. Interpretation is limited by the small sample size,
reflecting the early phase of a newly established clinic.
Conclusion:In this early audit, ROC care was associated with clinically
meaningful improvement in glycemic control and
significant insulin deintensification over 3 months. These
findings support the potential role of a structured multidisciplinary optimization clinic in delivering individualized
diabetes care and facilitating safe reduction of insulin
burden.
- Full text:2026072916470621199EP_A041.pdf
