Rationale for the establishment of a national integrated adult type 1 diabetes clinical center in a Mediterranean country: real-world experience and associated costs

Abstract

Objectives: Complex logistics, geographical distance, and waiting times compromise compliance and outcomes for patients with type 1 diabetes (T1D) in Greece. We evaluated guideline adherence of diabetologists and associated costs to outline the rationale for launching an integrated center with an interdisciplinary team, telemedicine, and continuous provider training.

Methods: An expert panel of diabetologists was invited to complete an anonymous survey on routine care of patients aged 18-50 with no major complications. The survey explored (1) guideline adherence and laboratory monitoring, (2) referrals and availability, and (3) perspectives on an integrated center. Annual laboratory costs per patient per provider were estimated and compared with guideline predictions.

Results: Seventeen experts completed the survey, representing over 60% of non-integrated diabetes centers. A high annual cost was estimated [median 183.22 euros vs. 94.8 indicated by guidelines, p = 0.033, 95% CI (77.06, 232.14)]. Most experts reported no telemedicine availability and viewed an integrated center as an effective healthcare improvement.

Conclusion: Our study identified increased costs, limited availability, and lack of remote monitoring, suggesting a centralized approach could reduce costs, streamline referrals, and improve care quality. However, these preliminary findings should be interpreted cautiously due to the small sample size.

Keywords: Diabetes center; diabetes care and education; guideline adherence; telemedicine; type 1 diabetes.