IDF2022-1260 Virtual case finding and diabetes specialist support for general practices in deprived areas

Nitin Gholap; H Randeva; Peter Zeh; Peter K Kimani; S Patel; K Johal; P O'Hare

doi:10.1016/j.diabres.2023.110437

Abstract

Background
In the UK, there is a drive to support general practices improve diabetes care and outcomes in deprived, multiethnic communities; new models of integrated diabetes care incorporating support and upskilling of these practices therefore needs developing.

Aim
To assess effectiveness of targeted support from a consultant-led diabetes team to UK general practices in deprived communities on improving outcomes.

Method
A pilot cluster-randomised trial involving 16 general practices from the 20% most deprived areas of a UK city. Consultant-lead multidisciplinary team supported practice staffs from the eight intervention practices manage patients not achieving diabetes treatment targets. Virtual patient data sharing using the Eclipse® diabetes data manager allowed case finding, advice and monitoring. A major focus was also on promoting staff and patient education. The other eight control practices provided usual care. Practice level, aggregate data for outcomes were analysed. Primary outcome was improvement in haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol (TC) after one year.

Results
The intervention practices (n = 2739) achieved improvement in HbA1c and BP while the control practices (n = 2268) noticed some progress in HbA1c and TC targets. Compared to control, the adjusted odds ratio (OR) for intervention practices with proportions of patients with Diastolic BP ≥90 mmHg (0.67 [0.44, 1.02], p = 0.063), Systolic BP ≥150 mmHg (0.88 [0.61, 1.27], p = 0.481), HbA1c ≥85 mmol/mol (0.92 [0.75, 1.13], p = 0.434), HbA1c ≥75 mmol/mol (0.94 [0.80, 1.11], p = 0.477) and HbA1c ≥59 (0.99 [0.86, 1.14], p = 0.929;) were lower whilst such OR were higher for TC:HDLC ratio ≥5 (1.16 [0.95, 1.41], p = 0.134) and TC ≥5 mmol/L (1.17 [1.01, 1.37], p = 0.041).

Conclusion
Targeted support from consultant-led team led to encouraging albeit statistically insignificant improvement in BP and glycaemic control than usual care. To achieve sustainable improvements in diabetes outcomes among deprived communities, this model can be refined further and adopted for the current primacy care network (PCN)-based working of practices in the UK.

Original language	English
Pages (from-to)	110437
Number of pages	1
Journal	Diabetes Research and Clinical Practice
Volume	197
Issue number	1
DOIs	https://doi.org/10.1016/j.diabres.2023.110437
Publication status	E-pub ahead of print - 15 Mar 2023
Event	International diabetes federation (IDF) congress Lisbon - Centro de Congressos de Lisboa CCL Praça das Indústrias 1 1300-307 Lisboa Portugal, Lisbon, Portugal Duration: 5 Dec 2022 → 8 Dec 2022 https://idf2022.org/

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1016/j.diabres.2023.110437

Cite this

@article{4ea15ad80f4844ecb72230b088db0696,

title = "IDF2022-1260 Virtual case finding and diabetes specialist support for general practices in deprived areas",

abstract = "Background In the UK, there is a drive to support general practices improve diabetes care and outcomes in deprived, multiethnic communities; new models of integrated diabetes care incorporating support and upskilling of these practices therefore needs developing. Aim To assess effectiveness of targeted support from a consultant-led diabetes team to UK general practices in deprived communities on improving outcomes. Method A pilot cluster-randomised trial involving 16 general practices from the 20\% most deprived areas of a UK city. Consultant-lead multidisciplinary team supported practice staffs from the eight intervention practices manage patients not achieving diabetes treatment targets. Virtual patient data sharing using the Eclipse{\textregistered} diabetes data manager allowed case finding, advice and monitoring. A major focus was also on promoting staff and patient education. The other eight control practices provided usual care. Practice level, aggregate data for outcomes were analysed. Primary outcome was improvement in haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol (TC) after one year. Results The intervention practices (n = 2739) achieved improvement in HbA1c and BP while the control practices (n = 2268) noticed some progress in HbA1c and TC targets. Compared to control, the adjusted odds ratio (OR) for intervention practices with proportions of patients with Diastolic BP ≥90 mmHg (0.67 [0.44, 1.02], p = 0.063), Systolic BP ≥150 mmHg (0.88 [0.61, 1.27], p = 0.481), HbA1c ≥85 mmol/mol (0.92 [0.75, 1.13], p = 0.434), HbA1c ≥75 mmol/mol (0.94 [0.80, 1.11], p = 0.477) and HbA1c ≥59 (0.99 [0.86, 1.14], p = 0.929;) were lower whilst such OR were higher for TC:HDLC ratio ≥5 (1.16 [0.95, 1.41], p = 0.134) and TC ≥5 mmol/L (1.17 [1.01, 1.37], p = 0.041). Conclusion Targeted support from consultant-led team led to encouraging albeit statistically insignificant improvement in BP and glycaemic control than usual care. To achieve sustainable improvements in diabetes outcomes among deprived communities, this model can be refined further and adopted for the current primacy care network (PCN)-based working of practices in the UK.",

author = "Nitin Gholap and H Randeva and Peter Zeh and Kimani, \{Peter K\} and S Patel and K Johal and P O'Hare",

year = "2023",

month = mar,

day = "15",

doi = "10.1016/j.diabres.2023.110437",

language = "English",

volume = "197",

pages = "110437",

journal = "Diabetes Research and Clinical Practice",

issn = "0168-8227",

publisher = "Elsevier Ireland Ltd",

number = "1",

note = "International diabetes federation (IDF) congress Lisbon, IDF Congress ; Conference date: 05-12-2022 Through 08-12-2022",

url = "https://idf2022.org/",

}

TY - JOUR

T1 - IDF2022-1260 Virtual case finding and diabetes specialist support for general practices in deprived areas

AU - Gholap , Nitin

AU - Randeva, H

AU - Zeh, Peter

AU - Kimani, Peter K

AU - Patel, S

AU - Johal, K

AU - O'Hare, P

PY - 2023/3/15

Y1 - 2023/3/15

N2 - Background In the UK, there is a drive to support general practices improve diabetes care and outcomes in deprived, multiethnic communities; new models of integrated diabetes care incorporating support and upskilling of these practices therefore needs developing. Aim To assess effectiveness of targeted support from a consultant-led diabetes team to UK general practices in deprived communities on improving outcomes. Method A pilot cluster-randomised trial involving 16 general practices from the 20% most deprived areas of a UK city. Consultant-lead multidisciplinary team supported practice staffs from the eight intervention practices manage patients not achieving diabetes treatment targets. Virtual patient data sharing using the Eclipse® diabetes data manager allowed case finding, advice and monitoring. A major focus was also on promoting staff and patient education. The other eight control practices provided usual care. Practice level, aggregate data for outcomes were analysed. Primary outcome was improvement in haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol (TC) after one year. Results The intervention practices (n = 2739) achieved improvement in HbA1c and BP while the control practices (n = 2268) noticed some progress in HbA1c and TC targets. Compared to control, the adjusted odds ratio (OR) for intervention practices with proportions of patients with Diastolic BP ≥90 mmHg (0.67 [0.44, 1.02], p = 0.063), Systolic BP ≥150 mmHg (0.88 [0.61, 1.27], p = 0.481), HbA1c ≥85 mmol/mol (0.92 [0.75, 1.13], p = 0.434), HbA1c ≥75 mmol/mol (0.94 [0.80, 1.11], p = 0.477) and HbA1c ≥59 (0.99 [0.86, 1.14], p = 0.929;) were lower whilst such OR were higher for TC:HDLC ratio ≥5 (1.16 [0.95, 1.41], p = 0.134) and TC ≥5 mmol/L (1.17 [1.01, 1.37], p = 0.041). Conclusion Targeted support from consultant-led team led to encouraging albeit statistically insignificant improvement in BP and glycaemic control than usual care. To achieve sustainable improvements in diabetes outcomes among deprived communities, this model can be refined further and adopted for the current primacy care network (PCN)-based working of practices in the UK.

AB - Background In the UK, there is a drive to support general practices improve diabetes care and outcomes in deprived, multiethnic communities; new models of integrated diabetes care incorporating support and upskilling of these practices therefore needs developing. Aim To assess effectiveness of targeted support from a consultant-led diabetes team to UK general practices in deprived communities on improving outcomes. Method A pilot cluster-randomised trial involving 16 general practices from the 20% most deprived areas of a UK city. Consultant-lead multidisciplinary team supported practice staffs from the eight intervention practices manage patients not achieving diabetes treatment targets. Virtual patient data sharing using the Eclipse® diabetes data manager allowed case finding, advice and monitoring. A major focus was also on promoting staff and patient education. The other eight control practices provided usual care. Practice level, aggregate data for outcomes were analysed. Primary outcome was improvement in haemoglobin A1c (HbA1c), blood pressure (BP), total cholesterol (TC) after one year. Results The intervention practices (n = 2739) achieved improvement in HbA1c and BP while the control practices (n = 2268) noticed some progress in HbA1c and TC targets. Compared to control, the adjusted odds ratio (OR) for intervention practices with proportions of patients with Diastolic BP ≥90 mmHg (0.67 [0.44, 1.02], p = 0.063), Systolic BP ≥150 mmHg (0.88 [0.61, 1.27], p = 0.481), HbA1c ≥85 mmol/mol (0.92 [0.75, 1.13], p = 0.434), HbA1c ≥75 mmol/mol (0.94 [0.80, 1.11], p = 0.477) and HbA1c ≥59 (0.99 [0.86, 1.14], p = 0.929;) were lower whilst such OR were higher for TC:HDLC ratio ≥5 (1.16 [0.95, 1.41], p = 0.134) and TC ≥5 mmol/L (1.17 [1.01, 1.37], p = 0.041). Conclusion Targeted support from consultant-led team led to encouraging albeit statistically insignificant improvement in BP and glycaemic control than usual care. To achieve sustainable improvements in diabetes outcomes among deprived communities, this model can be refined further and adopted for the current primacy care network (PCN)-based working of practices in the UK.

U2 - 10.1016/j.diabres.2023.110437

DO - 10.1016/j.diabres.2023.110437

M3 - Meeting Abstract

SN - 0168-8227

VL - 197

SP - 110437

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

IS - 1

T2 - International diabetes federation (IDF) congress Lisbon

Y2 - 5 December 2022 through 8 December 2022

ER -

IDF2022-1260 Virtual case finding and diabetes specialist support for general practices in deprived areas

Abstract

UN SDGs

Access to Document

Fingerprint

Cite this