2034-P: Glycemic Outcomes for Patients with Type 2 Diabetes Mellitus (DM2) and Hemoglobin A1c ≥10% Managed in Primary Care and Endocrinology Clinics and Indications for Endocrinology Referral

Introduction and Objective: There are no guidelines for referral of patients with uncontrolled DM2 to an endocrinologist. The study objective was to identify indications for endocrinology referral of patients with DM2 and poor glycemic control, defined as HbA1c ≥ 10%. Methods: This was a retrospective comparison of adults ≥ 18 y with DM2 and baseline A1c ≥ 10% managed by primary care providers (PCPs) at Southern Illinois University (SIU, N=165) or referred to SIU endocrinology (N=138) January 2019 through June 2023. Significant glycemic improvement was defined as ≥ 1% reduction in HbA1c 6- and/or 12-months from initial clinic visit. Indications for endocrinology referral were determined by multivariate logistic regression. Results: Endocrinology patients were older, had longer DM2 duration, higher prevalence of cardiovascular and chronic kidney disease, and more extensive treatment with insulin, GLP-1 receptor agonists, and SGLT2-inhibitors at baseline than PCP patients (P < 0.05 for comparisons). Endocrine clinic patients achieved significant glycemic improvement more than PCP patients (6-mo: 82% vs, 50%, P < 0.001); 12-mo: (89% vs. 59%, P < 0.001), and median HbA1c was lower (6-mo: 7.9% [6.8, 9.3] vs. 9.9% [7.1, 11.4], P < 0.001; 12-mo: 8.0% [7.0, 9.3] vs. 9.6% [7.1, 11.5], P < 0.001). Comparison of PCP patients achieving and not achieving significant glycemic improvement at 6-mo yielded compliance with PCP appointments (OR 22.73, 95% CI 2.92-166.67), addition of metformin (OR 9.09, 1.89-50.00), addition of GLP-1 receptor agonists (OR 5.56, 1.18-25.00), compliance with diabetes education appointments (OR 4.98, 1.40-17.54), and duration of DM2 ≤ 3 y (OR 1.12, 1.03-1.25) as predictors of significant glycemic improvement in the PCP cohort. Conclusion: DM2 patients with HbA1c ≥ 10% achieve best glycemic control in endocrinology clinic and should be referred unless DM2 duration is ≤ 3 y and patients are naïve to treatment with GLP-1 receptor agonists and/or metformin. Disclosure V. Williams: None. C. Catalano Jones: None. M.G. Jakoby: None.