Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .
A prospective randomized controlled study of a virtual clinic integrating primary and specialist care for patients with Type 2 diabetes mellitus.
AIMS To investigate the effectiveness of a diabetes virtual clinic to enhance diabetes in primary care by developing clinical management plans for patients with suboptimal metabolic control and /or case complexity . METHODS A prospect i ve study with r and omized allocation to virtual clinic or usual care .  Patients with Type 2 diabetes ( n = 208 ) were recruited from six general practice s in South London . The primary outcome for the study was glycaemic control , secondary outcomes included : lipids , blood pressure , weight ( kg and BMI ) and renal function ( eGFR ) . Data were collected from participants ' records at baseline and 12 months . We also considered process measures including therapy optimization . RESULTS The 12-month data show equivalence between the virtual clinic and control groups for glycaemic control with both achieving clinical ly significant reductions in HbA1c of 8 mmol/mol ( 0.6 ± 1.7 % ) and 10 mmol/mol ( 0.8 ± 1.9 % ) , respectively ( P = 0.4 ) . The virtual clinic group showed superiority over the intervention group for blood pressure control with a mean reduction in systolic blood pressure of 6 ± 16 mmHg compared with an increased of 2 ± 18 mmHg in the control group ( P = 0.008 ) . There were no significant differences between the groups in terms of cholesterol , weight and renal function . Process measures showed an increased level of therapy adjustment in the virtual clinic group . CONCLUSION The virtual clinic model explored in this study showed a clinical ly important improvement in glycaemic control . Although this improvement was not superior to that observed in the control participants , this might be attributable to the systemic impact of the virtual clinic on the practice as a whole
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .