Impact of a multicomponent healthcare intervention on glycaemic control in subjects with poorly controlled type 2 diabetes: The INTEGRA study

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2023-04, Vol.25 (4), p.1045-1055
• Main Authors: Molló, Àngels, Vlacho, Bogdan, Gratacòs, Mònica, Mata‐Cases, Manel, Rubinat, Esther, Berenguera, Anna, Real, Jordi, Puig‐Treserra, Ramon, Cos, Xavier, Franch‐Nadal, Josep, Khunti, Kamlesh, Mauricio, Dídac
• Format: Article
• Language: English
• Subjects: Antidiabetics; appropriate prescribing; Autoimmune Diseases; Delivery of Health Care; delivery of healthcare; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Disease management; Glucose monitoring; Glycated Hemoglobin; Glycemic Control; Health care; Humans; Hypoglycemic Agents - therapeutic use; interventions; Patient education; Patient-centered care; Primary care; primary healthcare/methods; quality improvement; type 2 diabetes
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.14951

Aim To evaluate whether a specially designed multicomponent healthcare intervention improves glycaemic control in subjects with poorly controlled type 2 diabetes. Materials and Methods A cluster, non‐randomized, controlled, pragmatic trial in subjects from 11 primary care centres with type 2 diabetes and HbA1c of more than 9% (> 75 mmol/mol) was conducted. The intervention (N = 225 subjects) was professional and patient‐centred, including a dedicated monographic visit that encouraged therapeutic intensification by physicians. The sham control (N = 181) was identical to that of the intervention group except that the dedicated visit was omitted. The primary outcome was to compare the reductions in HbA1c values between the groups at 12 months of follow‐up. Results The mean age at baseline was 59.5 years, mean diabetes duration was 10.7 years and mean HbA1c was 10.3% (89.0 mmol/mol). Patients in the intervention arm achieved significantly greater HbA1c reduction than those in the sham control group at 12 months (mean difference −0.62%, 95% CI = −0.2%, −1.04%; P = .002). A larger percentage of intervention participants achieved an HbA1c of less than 8% (44.8% vs. 25.5%; P = .003) and were more frequently treated with more than three antidiabetic therapies (14.4% vs. 3.5%; P = .0008). Intervention was the only variable associated with higher odds of HbA1c less than 8% (odds ratio = 2.52; 95% CI = 1.54‐4.12; P