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Research Article| Volume 113, P1-13, March 2016

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A systematic review of interventions targeting primary care or community based professionals on cardio-metabolic risk factor control in people with diabetes

  • S. Seidu
    Correspondence
    Corresponding author at: University of Leicester, Diabetes Research Centre, Leicester General Hospital, Leicester Diabetes Centre, Gwendolen Road, Leicester LE5 4WP, UK. Tel.: +44 07525191097; fax: +44 07525191097.
    Affiliations
    Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK

    Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
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  • N.S. Walker
    Affiliations
    Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK
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  • D.H. Bodicoat
    Affiliations
    Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK

    Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
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  • M.J. Davies
    Affiliations
    Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK

    Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
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  • K. Khunti
    Affiliations
    Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK

    Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK
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Published:January 21, 2016DOI:https://doi.org/10.1016/j.diabres.2016.01.022

      Abstract

      Objective

      To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes.

      Research design and methods

      A systematic review of randomised controlled trials evaluating the effectiveness of interventions targeting primary care or community based professionals on diabetes and cardiovascular risk factor control. We conducted searches in MEDLINE database from inception up to 27th September 2015. We also retrieved articles related to diabetes from the Cochrane EPOC database and EMBASE and scanned bibliographies for key articles.

      Results

      There was heterogeneity in terms of interventions and participants amongst the 30 studies (39,439 patients) that met the inclusion criteria. Nine of the studies focused on general or family practitioners, five on pharmacists, three on nurses and one each on dieticians and community workers. Twelve studies targeted multi-disciplinary teams.
      Educational interventions did not seem to have a positive impact on HbA1c, systolic blood pressure or lipid profiles. The use of telemedicine, clinician reminders and feedback showed mixed results but there was a level of consistency in improvement in HbA1c when multifaceted interventions on multidisciplinary teams were implemented. Targeting general or family physicians was largely ineffective in improving the cardiovascular risk factors considered, except when using a computer application on insulin handling of type 2 diabetes or customised simulated cases with feedbacks. Similarly, interventions targeting nurses did not improve outcomes compared to standard care.

      Conclusions

      Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control.

      Keywords

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