Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of non-pharmaceutical interventions in primary care and community settings

Conference:

SAPC ASM 2016 - Dublin

Talk Code:

P2.11

Presenter:

Mark Murphy

Co-authors:

Dr. Rose Galvin, Professor Tom Fahey, Dr. Fiona Boland, Dr. Molly Byrne, Professor Susan M Smith

Author institutions:

HRB Centre for Primary Care Research, RCSI, Ireland. Department of Physiotherapy, University of Limerick, Ireland. Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.

Problem

Poorly-controlled type 2 diabetes mellitus (T2DM) is major international health problem. Our aim was to assess the effectiveness of healthcare professional-led interventions, targeting poorly-controlled T2DM and seeking to improve glycaemic control and cardiovascular risk in primary care and community settings.

Approach

A systematic review of RCTs was undertaken, which targeted patients with poor glycaemic control. Poor T2DM control was defined as a HbA1c over 68 mmol/ mol (7.5%). Primary outcomes were HbA1c, systolic blood pressure (BP) and lipids. Secondary outcomes included patient reported outcome measures and health care utilisation. Two reviewers independently assessed studies for eligibility, extracted data, and assessed study quality. Meta-analysis and meta-regression were undertaken to explore the effects of interventions and to examine the impact of different study characteristics on HbA1c and BP.

Findings

12,181 titles were screened. 32 RCTs were identified, comprising 6,848 patients. The risk of bias was predominantly low across studies. The predominant intervention-types were patient-directed (50%) and organisational (44%). In studies with shorter follow up (≤10 months), interventions reduced HbA1c compared to controls (MD – 0.28 (CI: (-0.45, -0.10), with patient-directed interventions or interventions on those with baseline HbA1c over 9.5% showing the greatest benefit. In studies with longer follow-up (≥ 12 months), interventions also reduced HbA1c compared to controls (MD -0.48 (CI: -0.69, -0.27)) but had high heterogeneity. Meta-regression indicated that organisational interventions showed a greater reduction in HbA1c overall compared to patient-centred interventions (β-Coefficient -0.29, p=0.043) .

Consequences

Interventions for T2DM in community settings targeting patients with poor control show modest but positive effects. This review suggests that Interventions are more effective if they target patients with very poor control and enhance organisational elements of care.

Submitted by:

Mark Murphy

Funding acknowledgement:

Funded by HRB Centre for Primary Care Research.