Abstract
Background
In the UK, there is a drive to support general practices improve diabetes care and outcomes in deprived, multi-ethnic 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.
In the UK, there is a drive to support general practices improve diabetes care and outcomes in deprived, multi-ethnic 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 |
|---|---|
| Publication status | Published - 7 Dec 2022 |
| 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/ |
Conference
| Conference | International diabetes federation (IDF) congress Lisbon |
|---|---|
| Abbreviated title | IDF Congress |
| Country/Territory | Portugal |
| City | Lisbon |
| Period | 5/12/22 → 8/12/22 |
| Internet address |
