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 .
The GIANT study, a cluster-randomised controlled trial of efficacy of education of doctors about type 2 diabetes mellitus management guidelines in primary care practice.
OBJECTIVES Primary aim : does general practitioner ( GP ) education on type 2 diabetes treatment improve HbA1c ? Secondary aim : cardiovascular risk factors , hypoglycaemia , treatment intensification , health service utilisation , treatment barriers . METHODS 99 Asia-Pacific GPs were cluster-r and omised to be educated on regional diabetes management guidelines ( intervention ) or continue st and ard care ( control ) . The intervention employed meetings , reminders , medical record summary sheets and patient result cards . Each GP recruited four type 2 diabetic patients , assessed at baseline , 6 and 12 months . The primary outcome was mean change in HbA1c from 0 to 6 months in patients with baseline HbA1c≥6.5 % . RESULTS 361 patients ( 93 % ) completed 6 month follow-up . The primary HbA1c outcome was -0.11 % ( 95 % CI -0.27 , 0.05 ) with intervention and -0.22 % ( 95 % CI -0.39 , -0.05 ) in the control group ( p=0.340 ) . The groups did not differ in control of other glycaemic indices , blood pressure or lipids after 6 or 12 months . In those with HbA1c≥9.0 % , approximately 50 % received intensified treatment by 6 months , and 30 % in the final 6 months . GPs identified treatment costs and patient reluctance to use insulin as management barriers . CONCLUSIONS /INTERPRETATION A structured GP education programme did not improve HbA1c in patients with type 2 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 .