scholarly journals Effects of an electronic software ‘prompt’ with healthcare professional training on cardiovascular and renal complications in a multi-ethnic population with Type 2 Diabetes and Microalbuminuria (The GP Prompt study): results of a pragmatic cluster randomised trial.

2020 ◽  
Author(s):  
Andrew Willis ◽  
Winston Crasto ◽  
Laura J Gray ◽  
Helen Dallosso ◽  
Ghazala Waheed ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

<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>

scholarly journals Effects of an electronic software ‘prompt’ with healthcare professional training on cardiovascular and renal complications in a multi-ethnic population with Type 2 Diabetes and Microalbuminuria (The GP Prompt study): results of a pragmatic cluster randomised trial.

2020 ◽  
Author(s):  
Andrew Willis ◽  
Winston Crasto ◽  
Laura J Gray ◽  
Helen Dallosso ◽  
Ghazala Waheed ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

<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>

scholarly journals Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019981 ◽  
Author(s):  
David Guwatudde ◽  
Pilvikki Absetz ◽  
Peter Delobelle ◽  
Claes-Göran Östenson ◽  
Josefien Olmen Van ◽  
...  
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Plasma Glucose ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Ethics Committee ◽  
Community Interventions ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

IntroductionType 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes.Methods and analysisAn adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in self-management, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose.Ethics and disseminationThe study has received approval in Uganda from the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and from the Uganda National Council for Science and Technology; in South Africa from the Biomedical Science Research Ethics Committee of the University of the Western Cape; and in Sweden from the Regional Ethical Board in Stockholm. Findings will be disseminated through peer-reviewed publications and scientific meetings.Trial registration numberISRCTN11913581; Pre-results.

scholarly journals Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

The Lancet ◽  
2018 ◽  
Vol 391 (10120) ◽  
pp. 541-551 ◽  
Author(s):  
Michael EJ Lean ◽  
Wilma S Leslie ◽  
Alison C Barnes ◽  
Naomi Brosnahan ◽  
George Thom ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Weight Management ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Open Label ◽  
Cluster Randomised

scholarly journals Use of the Diabetes Medication Choice Decision Aid in patients with type 2 diabetes in Greece: a cluster randomised trial

BMJ Open ◽  
2016 ◽  
Vol 6 (11) ◽  
pp. e012185 ◽  
Author(s):  
Thomas Karagiannis ◽  
Aris Liakos ◽  
Megan E Branda ◽  
Eleni Athanasiadou ◽  
Maria Mainou ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Decision Aid ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Diabetes Medication ◽  
Cluster Randomised ◽  
Choice Decision ◽  
Medication Choice

scholarly journals Effects of telephone-delivered lifestyle support on the development of diabetes in participants at high risk of type 2 diabetes: J-DOIT1, a pragmatic cluster randomised trial

BMJ Open ◽  
2015 ◽  
Vol 5 (8) ◽  
pp. e007316 ◽  
Author(s):  
Naoki Sakane ◽  
Kazuhiko Kotani ◽  
Kaoru Takahashi ◽  
Yoshiko Sano ◽  
Kokoro Tsuzaki ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

scholarly journals Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0207653
Author(s):  
Maaike C. M. Ronda ◽  
Lioe-Ting Dijkhorst-Oei ◽  
Rimke C. Vos ◽  
Paul Westers ◽  
Guy E. H. M. Rutten
Keyword(s):  
Type 2 Diabetes ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised
Sign in / Sign up

Export Citation Format

Share Document