| Abstrakt: |
Aims: The Microalbuminuria Education Medication and Optimisation (MEMO) study, revealed improved cardiovascular risk and glycaemic control with 18 months of intensive multifactorial intervention in high‐risk people with type 2 diabetes, without any increase in severe hypoglycaemia. Our aim was to assess longer‐term outcomes at 4‐year follow‐up in these participants. Methods: Some 189 individuals with type 2 diabetes and microalbuminuria were recruited from a multi‐ethnic population in Leicestershire, UK. The intervention group (n = 95) received multifactorial intervention with self‐management education, and the control group (n = 94) received usual care. The primary outcome was change in HbA1c, and secondary outcomes were blood pressure (BP), cholesterol, microalbuminuria, estimated GFR, cardiovascular risk scores and major adverse cardiovascular events. Results: Some 130 participants (68.7%), mean (sd) age 60.8 (10.4) years, duration of diabetes 11.5 (9.7) years, completed 4 years of follow‐up. Mean change [95% confidence intervals (CI)] in HbA1c over 4 years was greater with intensive intervention compared with control (−3 mmol/mol, 95% CI −4.95,−1.11; −0.4%, 95% CI −0.67,−0.15; P = 0.002). Significant improvements over the 4 years were also seen in systolic BP (−7.3 mmHg, 95% CI −11.1, −3.5; P < 0.001), diastolic BP (−2.9 mmHg, 95% CI −5.4, −0.3; P = 0.026), cholesterol (−0.3 mmol/l, 95% CI −0.52,−0.12; P = 0.002), and 10‐year coronary heart disease (−5.3, 95% CI −8.2,−2.3; P < 0.001) and stroke risk (−4.4, 95% CI −7.5, −1.3; P < 0.001). Conclusion: Multifactorial intervention with structured diabetes self‐management education compared with usual diabetes care has benefits for cardio‐metabolic risk factor profile. There was no increase in severe hypoglycaemia and cardiovascular mortality despite intensive glycaemic control, although the study was not powered to assess these outcomes. What's new?: A complex intervention that addresses control of multiple risk factors with structured self‐management education in high‐risk individuals with type 2 diabetes shows favourable improvements in cardio‐metabolic risk compared with usual diabetes care.Structured self‐management education programmes are vital because they empower individuals to learn more about their own long‐term condition, and facilitate skills‐based learning and decision support (i.e. provide guidance for implementing evidence‐based care).A recent systematic review that studied the effects of multifaceted diabetes care in European populations showed that biomedical outcomes improved significantly in people with newly diagnosed diabetes compared with those with prevalent diabetes. Our study adds to this body of evidence and suggests that a comprehensive multifactorial care intervention with structured self‐management education is beneficial in people with established type 2 diabetes. [ABSTRACT FROM AUTHOR] |
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