<b>Background:</b> Tight, targeted control of
modifiable cardiovascular risk factors can reduce cardiovascular complications
and mortality in individuals with type 2 diabetes (T2DM) and microalbuminuria.
The effects of using an electronic “Prompt” with a treatment algorithm to
support a treat-to-target approach has not been tested in primary care.
<p><b>Methods:</b> A multi-centre,
cluster-randomised trial among primary care practices across Leicestershire,
UK. Primary outcome was proportion of individuals achieving systolic and diastolic
blood pressure (<130 and <80mmHg, respectively) and total cholesterol
(<3.5mmol/l) targets at 24 months. Secondary outcomes included proportion of
individuals with HbA1c<58 mmol/mol (<7.5%), changes in prescribing,
change in albumin-creatinine ratio, major adverse cardiovascular events,
cardiovascular mortality and coding accuracy.</p>
<p><b>Results:</b> 2721 individuals from 22
practices, mean age 63 years, 41% female, 62% from Black and Minority Ethnic
groups, completed two years follow-up. There were no significant differences in
the proportion of individuals achieving the composite primary outcome, although
the proportion of individuals achieving the pre-specified outcome of total
cholesterol <4.0 mmol (Odds Ratio 1.24(1.05,1.47),p=0.01) increased with
intensive intervention compared to control. Coding for microalbuminuria
increased relative to control (Odds Ratio 2.05 (1.29, 3.25), p< 0.01]).</p>
<p><b>Conclusions:</b> Greater improvements in composite
cardiovascular risk factor control with this intervention compared to standard
care were not achieved in this cohort of high-risk individuals with T2DM. However,
improvements in lipid profile and coding can benefit patients with diabetes to
alter the high risk of atherosclerotic cardiovascular events. Future studies
should consider comprehensive strategies including patient education and
healthcare professional engagement, in the management of T2DM.</p>
<p><b> </b></p>