Effectiveness of a Treat-to-target Clinic Led by a Nurse Consultants
Condition: Diabetes
MeSH terms: Diabetes Mellitus
Study type: Interventional

Summary: 
      The investigators hypothesize a diabetes nurse consultant led team with particular emphasis
      on compliance and attainment of treatment targets in Type 2 diabetic patients will achieve
      metabolic control, improve clinical outcomes and levels of self efficacy compared to usual
      clinic-based care.
    

Detailed description: 
      Diabetes patients consume over 10% of health care costs in most developed countries. Over 80%
      of these resources are used to treat diabetic complications and late stage diseases. In Hong
      Kong, the prevalence of diabetes was reported to be 10%. Over 30% of patients admitted to the
      medical wards in Hong Kong's public hospitals have diabetes, mainly due to cardiovascular and
      renal complications. The number of patients receiving renal replacement therapy has increased
      by 50% in the last 5 years but the number of patients with end stage renal disease due to
      diabetes has doubled. Between 10% and 15% of patients attending medical clinics in local
      public hospitals either receive insulin or anti-diabetic drugs. Local published data show
      that 3-10% of diabetic patients died or developed clinical endpoints yearly.

      There are now overwhelming evidence supporting the beneficial effects of optimal control of
      cardiovascular risk factors on clinical outcomes in diabetic patients. However, there are few
      studies to examine the most effective way to translate these evidence collected in closely
      monitored clinical trials situations into daily clinical practice. Against this background,
      the investigators hypothesize that disease management using a team approach to implement a
      structured care model in daily clinical practice will improve the clinical outcomes in high
      risk Type 2 diabetic patients compared to usual clinic-based care with no specific built in
      protocol and/or monitoring mechanism to ensure its effective implementation. The nurse
      consultant led clinics will use a structured protocol with particular emphasis on periodic
      monitoring, treating to target and reinforcing patient adherence.

      In light of the size of diabetes epidemic, the constraints of finite resources and the need
      for equity, the investigators propose the results from this randomized study will provide
      information to health care policy makers regarding the effectiveness of diabetes nurse
      consultant led clinics in managing diabetic patients.
    

Intervention name(s): Structured care led by a nurse consultant
Intervention type(s): Other
Intervention description(s): For the intervention group, patients will be followed up according to the following protocol. The structured care team consists of:
i) Diabetes Nurse Consultant to reinforce compliance; educate patients on insulin injection techniques and reinforce self-care including self blood glucose monitoring and lifestyle interventions, titration of medication.
ii) Technical Service Assistance to remind patients to take medications and/or give insulin injection, monitor blood glucose as prescribed, attend their next clinic appointment, encourage patients to report all side effects, self initiated change in regimen or concerns to diabetes nurse consultant and/or their doctors at the next follow up visit.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Diabetes; Structured Care