Effects of a Technology-Assisted Integrated Diabetes Care Program on Cardiometabolic Risk Factors Among Patients With Type 2 Diabetes in the Asia-Pacific Region

Autor: Uday Phadke, Duc-Cong Nguyen, Eric S.H. Lau, Banshi Saboo, Lee Ling Lim, Vanessa Lau, Yi-Jen Hung, Aravind Sosale, Parinya Chamnan, Su-Yen Goh, Ronald C.W. Ma, Thi Thanh Huyen Vu, Jothydev Kesavadev, Neeru Gera, Lee-Ming Chuang, Andrea O.Y. Luk, Alexander Tong Boon Tan, Manoj Chawla, Amy W C Fu, Juliana C.N. Chan, Subir Ray, Alice P.S. Kong, Yook Chin Chia, Wayne Huey-Herng Sheu
Rok vydání: 2021
Předmět:
Male
Technology
Psychological intervention
Blood Pressure
Type 2 diabetes
law.invention
chemistry.chemical_compound
Randomized controlled trial
law
Neoplasms
Medicine
Diabetic Nephropathies
Asia
Southeastern
Original Investigation
Evidence-Based Medicine
Disease Management
General Medicine
Middle Aged
Quality Improvement
Diabetic Foot
Online Only
Diabetes and Endocrinology
Cardiovascular Diseases
Female
medicine.medical_specialty
Taiwan
India
Risk Assessment
Amputation
Surgical
Internal medicine
Diabetes mellitus
Humans
Mortality
Renal Insufficiency
Chronic
Developing Countries
Aged
Glycated Hemoglobin
Diabetic Retinopathy
Intention-to-treat analysis
business.industry
Self-Management
Research
Cardiometabolic Risk Factors
Cholesterol
LDL
Odds ratio
Decision Support Systems
Clinical
medicine.disease
Treatment Adherence and Compliance
Clinical trial
Diabetes Mellitus
Type 2
chemistry
Glycated hemoglobin
Patient Participation
business
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: Key Points Question What are the effects of a quality improvement intervention on the care and cardiometabolic risk factors of patients with type 2 diabetes in low- and middle-income countries in the Asia-Pacific region? Findings In this randomized clinical trial of 20 834 patients with type 2 diabetes in 8 Asia-Pacific countries, the intervention group received a technology-guided structured evaluation, automated personalized reports to encourage patient empowerment, and nurse reminders to increase patient engagement over a 12-month period. Clinical events were similar between the control and intervention groups at 12 months; however, the intervention group was more likely to experience reductions in multiple risk factors and increases in the attainment of diabetes-associated targets. Meaning The study’s findings indicate that the use of information and communications technology and nurses to empower and engage patients did not change the number of clinical events but did reduce cardiometabolic risk factors among patients with type 2 diabetes in low- and middle-income countries.
Importance Many health care systems lack the efficiency, preparedness, or resources needed to address the increasing number of patients with type 2 diabetes, especially in low- and middle-income countries. Objective To examine the effects of a quality improvement intervention comprising information and communications technology and contact with nonphysician personnel on the care and cardiometabolic risk factors of patients with type 2 diabetes in 8 Asia-Pacific countries. Design, Setting, and Participants This 12-month multinational open-label randomized clinical trial was conducted from June 28, 2012, to April 28, 2016, at 50 primary care or hospital-based diabetes centers in 8 Asia-Pacific countries (India, Indonesia, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam). Six countries were low and middle income, and 2 countries were high income. The study was conducted in 2 phases; phase 1 enrolled 7537 participants, and phase 2 enrolled 13 297 participants. Participants in both phases were randomized on a 1:1 ratio to intervention or control groups. Data were analyzed by intention to treat and per protocol from July 3, 2019, to July 21, 2020. Interventions In both phases, the intervention group received 3 care components: a nurse-led Joint Asia Diabetes Evaluation (JADE) technology-guided structured evaluation, automated personalized reports to encourage patient empowerment, and 2 or more telephone or face-to-face contacts by nurses to increase patient engagement. In phase 1, the control group received the JADE technology–guided structured evaluation and automated personalized reports. In phase 2, the control group received the JADE technology–guided structured evaluation only. Main Outcomes and Measures The primary outcome was the incidence of a composite of diabetes-associated end points, including cardiovascular disease, chronic kidney disease, visual impairment or eye surgery, lower extremity amputation or foot ulcers requiring hospitalization, all-site cancers, and death. The secondary outcomes were the attainment of 2 or more primary diabetes-associated targets (glycated hemoglobin A1c
This randomized clinical trial examines the effects of a quality improvement intervention comprising information and communications technology and increased contact with nurses on the clinical care and cardiometabolic risk factors of patients with type 2 diabetes in Asia-Pacific countries.
Databáze: OpenAIRE
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