Evaluation of the clinical and cost effectiveness of intermediate care clinics for diabetes (ICCD): a multicentre cluster randomised controlled trial

A. Wilson, J.P. O’Hare, A. Hardy, N. Raymond, Ala Szczepura, R. Crossman, Darrin Baines, K. Khunti, S. Kumar, P. Saravanan, ICCD trial group

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Background: Configuring high quality care for the rapidly increasing number of people with type 2 diabetes (T2D) is a major challenge worldwide for both providers and commissioners. In the UK, about two thirds of people with T2D are managed entirely in primary care, with wide variation in management strategies and achievement of targets. Pay for performance, introduced in 2004, initially resulted in improvements but disparities exist in ethnic minorities and the improvements are levelling off. Community based, intermediate care clinics for diabetes (ICCDs) were considered one solution and are functioning across the UK. However, there is no randomised trial evidence for the effectiveness of such clinics. Trial Design, Methods and Findings: This is a cluster-randomised trial, involving 3 primary care trusts, with 49 general practices randomised to usual care (n = 25) or intervention (ICCDs; n = 24). All eligible adult patients with T2D were invited; 1997 were recruited and 1280 followed-up after 18-months intervention. Primary outcome: achievement of all three of the NICE targets [(HbA1c≤7.0%/53 mmol/mol; Blood Pressure
Original languageEnglish
Article numbere93964
JournalPLoS ONE
Issue number4
Publication statusPublished - 15 Apr 2014
Externally publishedYes

Bibliographical note

ClinicalTrials.gov NCT00945204; National Research Register (NRR) M0014178167. : The study is funded by National Institute for Health Research (NIHR) - Health Services and Delivery Research (HS&DR) stream (previously known as NIHR SDO). This is a UK government funding (publicly funded) body. Project number: SDO/110/2005; Initial service for support costs was provided by Department of health.NHS Leicester City, Thames Valley Diabetes Research Network (TVDRN), West Midlands South Comprehensive Local Research Network (CLRN), Primary Care Research Network (PCRN) and DIERT charity provided additional support for the successful completion of the study. Please note Coventry author Dr Baines was working at the University of Warwick at the time of publication.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, http://creativecommons.org/licenses/by/4.0/ which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • diabetes
  • intermediate care clinics
  • cost-effectiveness
  • clinical effectiveness


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