Educational interventions did not seem to have a positive impact on HbA1c , systolic blood pressure or lipid profiles .
The use of telemedicine , clinician reminders and feedback showed mixed results but there was a level of consistency in improvement in HbA1c when multifaceted interventions on multidisciplinary teams were implemented .
Targeting general or family physicians was largely ineffective in improving the cardiovascular risk factors considered , except when using a computer application on insulin h and ling of type 2 diabetes or customised simulated cases with feedbacks .
Similarly , interventions targeting nurses did not improve outcomes compared to st and ard care .
Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control
OBJECTIVE To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes .
Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study): a cluster randomised controlled trial
BACKGROUND Delivery of high- quality , evidence -based health care to deprived sectors of the community is a major goal for society . We investigated the effectiveness of a culturally sensitive , enhanced care package in UK general practice s for improvement of cardiovascular risk factors in patients of south Asian origin with type 2 diabetes . METHODS In this cluster r and omised controlled trial , 21 inner-city practice s in the UK were assigned by simple r and omisation to intervention ( enhanced care including additional time with practice nurse and support from a link worker and diabetes-specialist nurse [ nine practice s ; n=868 ] ) or control ( st and ard care [ 12 practice s ; n=618 ] ) groups . All adult patients of south Asian origin with type 2 diabetes were eligible . Prescribing algorithms with clearly defined targets were provided for all practice s. Primary outcomes were changes in blood pressure , total cholesterol , and glycaemic control ( haemoglobin A1c ) after 2 years . Analysis was by intention to treat . This trial is registered , number IS RCT N 38297969 . FINDINGS We recorded significant differences between treatment groups in diastolic blood pressure ( 1.91 [ 95 % CI -2.88 to -0.94 ] mm Hg , p=0.0001 ) and mean arterial pressure ( 1.36 [ -2.49 to -0.23 ] mm Hg , p=0.0180 ) , after adjustment for confounders and clustering . We noted no significant differences between groups for total cholesterol ( 0.03 [ -0.04 to 0.11 ] mmol/L ) , systolic blood pressure ( -0.33 [ -2.41 to 1.75 ] mm Hg ) , or HbA1c ( -0.15 % [ -0.33 to 0.03 ] ) . Economic analysis suggests that the nurse-led intervention was not cost effective ( incremental cost-effectiveness ratio pound28 933 per QALY gained ) . Across the whole study population over the 2 years of the trial , systolic blood pressure , diastolic blood pressure , and cholesterol decreased significantly by 4.9 ( 95 % CI 4.0 - 5.9 ) mm Hg , 3.8 ( 3.2 - 4.4 ) mm Hg , and 0.45 ( 0.40 - 0.51 ) mmol/L , respectively , and we recorded a small and non-significant increase for haemoglobin A1c ( 0.04 % [ -0.04 to 0.13 ] ) , p=0.290 ) . INTERPRETATION We recorded additional , although small , benefits from our culturally tailored care package that were greater than the secular changes achieved in the UK in recent years . Stricter targets in general practice and further measures to motivate patients are needed to achieve best possible health-care outcomes in south Asian patients with diabetes
Educational interventions did not seem to have a positive impact on HbA1c , systolic blood pressure or lipid profiles .
The use of telemedicine , clinician reminders and feedback showed mixed results but there was a level of consistency in improvement in HbA1c when multifaceted interventions on multidisciplinary teams were implemented .
Targeting general or family physicians was largely ineffective in improving the cardiovascular risk factors considered , except when using a computer application on insulin h and ling of type 2 diabetes or customised simulated cases with feedbacks .
Similarly , interventions targeting nurses did not improve outcomes compared to st and ard care .
Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control
OBJECTIVE To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes .