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Multifactorial diabetes intervention reduces long-term HbA1c, BP more effectively than standard care
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Adults with type 2 diabetes who took part in a multifactorial intervention that included structured education had their long-term measures of HbA1c, blood pressure and coronary heart disease risk lowered more substantially than those who received usual care, according to findings published in Diabetic Medicine.
“In recent years, the management of type 2 diabetes has moved away from a one-dimensional, biomedical approach to individualized, targeted, multifactorial care with self-management education,” Melanie J. Davies, CBE, MB, ChB, MD, FRCP, FRCGP, professor of diabetes medicine in the Diabetes Research Centre and department of health sciences at the University of Leicester and Leicester General Hospital in the U.K., and colleagues wrote. “Structured self-management education programs are vital because they empower individuals to learn more about their own long-term condition [and] facilitate skills-based learning and decision support.”
Davies and colleagues analyzed 4-year data from 130 participants from the Microalbuminuria Education and Medication Optimisation (MEMO) study. Researchers originally randomly assigned participants to an 18-month intensive intervention or standard care. The intervention incorporated the Diabetes Education and Self-Management for Ongoing Newly Diagnosed (DESMOND) program and included group and personal sessions that provided education on optimal self-care practices and individualized targets for HbA1c, cholesterol and blood pressure. Davies and colleagues’ analysis included 70 intervention participants (mean age, 60.8 years; 20% women) and 60 participants who received standard care (mean age, 60.7 years; 23.3% women). Davies and colleagues measured HbA1c, BP, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, estimated glomerular filtration rate and calculated CHD and stroke risk annually.
At 4 years, compared with the standard care group, participants in the intervention group had their HbA1c reduced from baseline by a mean of 2.88 mmol/mol or 0.39% more (P = .01), their systolic BP reduced by a mean of 7.3 mm Hg more (P < .0001) and their diastolic BP reduced by a mean of 2.85 mm Hg more (P = .03). Participants in the intervention group also had their total cholesterol and LDL cholesterol reduced from baseline by a mean of 0.32 mmol/L more (P = .002) and 0.33 mmol/L (P < .001) more, respectively, than the those in the standard care group at 4 years. In addition, participants in the intervention had their 10-year CHD risk score reduced from baseline by a mean of 5.31 more points (P < .001) and their 10-year stroke risk score reduced by 4.41 more points (P = .01) than those in the standard care group.
The researchers noted that participants who received the intervention experienced a mean of 28 moderate hypoglycemic events while those who received standard care experienced nine such events (P = .01).
“Although structured education has proven value, the MEMO study based on the DESMOND philosophy and principles of structured self-management education and patient empowerment is the first intervention to show that structured education alongside medication optimization offers cardiometabolic risk factor benefits and long-term reductions in cardiovascular risk,” the researchers wrote. “Our study adds to the body of this evidence and suggests that a comprehensive multifactorial care intervention with structured self-management education is beneficial even in people with established type 2 diabetes.” – by Phil Neuffer
Disclosures: Davies reports she has acted as consultant, advisory board member and speaker for AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, Merck Sharp & Dohme, Novo Nordisk and Sanofi-Aventis; as a speaker for Mitsubishi Tanabe Pharma Corp. and has received grant support from Lilly, Novo Nordisk and Sanofi-Aventis. Please see the study for all other authors’ relevant financial disclosures.
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