Effectiveness of integrated diabetes care interventions involving diabetes specialists working in primary and community care settings: A systematic review and meta-analysis

Date
2022
Authors
Zarora, Reetu
Immanuel, Jincy
Chivese, Tawanda
MacMillan, Freya
Simmons, David
Journal Title
Journal ISSN
Volume Title
Publisher
Ubiquity Press
Abstract

Introduction: Evidence that integrated diabetes care interventions can substantially improve clinical outcomes is mixed. However, previous systematic reviews have not focussed on clinical effectiveness where the endocrinologist was actively involved in guiding diabetes management.


Methods: We searched EMBASE, COCHRANE, MEDLINE, SCOPUS, CINAHL, Google Scholar databases and grey literature published in English language up to 25 January 2021. Reviewed articles included Randomised Controlled Trials (RCTs) and pre-post studies testing the effectiveness on clinical outcomes after ≥6 months intervention in nonpregnant adults (age ≥ 18 years) with type 1 or type 2 diabetes mellitus. Two reviewers independently extracted data and completed a risk of bias assessment. Appropriate metaanalyses for each outcome from RCTs and pre-post studies were performed. Heterogeneity was assessed using the I2 statistic and Cochran’s Q and publication bias assessed using Doi plots. Studies were not pooled to estimate the cost-effectiveness as the cost outcomes were not comparable across trials/studies.


Results: We reviewed 4 RCTs and 12 pre-post studies. The integrated care model of diabetes specialists working with primary care health professionals had a positive impact on HbA1c in both RCTs and pre-post studies and on systolic blood pressure, diastolic blood pressure, total cholesterol and weight in pre-post studies. In the RCTs, interventions reduced HbA1c (–0.10% [–0.15 to –0.05]) (–1.1 mmol/mol [–1.6 to –0.5]), versus control. Pre-post studies demonstrated improvements in HbA1c (–0.77% [–1.12 to –0.42]) (–8.4 mmol/mol [–12.2 to –4.6]), systolic blood pressure (–3.30 mmHg [–5.16 to –1.44]), diastolic blood pressure (–3.61 mmHg [–4.82 to –2.39]), total cholesterol (–0.33 mmol/L [–0.52 to –0.14]) and weight (–2.53 kg [–3.86 to –1.19]). In a pre-post study with no control group only 4% patients experienced hypoglycaemia after one year of intervention compared to baseline.


Conclusions: Integrated interventions with an active endocrinologist involvement can result in modest improvements in HbA1c, blood pressure and weight management. Although the improvements per clinical outcome are modest, there is possible net improvements at a holistic level.

Description
Article originally published in International Journal of Integrated Care, 22(0), 11. English. Published online 2022. https://doi.org/10.5334/ijic.6025
Keywords
Integrated health care systems, Multidisciplinary care, Primary health care, Diabetes mellitus, Cost-effectiveness, Clinical outcome
Citation
This is a published version of an article that is available at: https://doi.org/10.5334/ijic.6025. Recommended citation: Zarora, R., Immanuel, J., Chivese, T., MacMillan, F., & Simmons, D. (2022). Effectiveness of integrated diabetes care interventions involving diabetes specialists working in primary and community care settings: A systematic review and meta-analysis. International Journal of Integrated Care, 22(0), 11. This item has been deposited in accordance with publisher copyright and licensing terms and with the author’s permission.
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