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Effectiveness of enhanced diabetes care to patients of South Asian ethnicity : the United Kingdom Asian Diabetes Study (UKADS) : a cluster randomised controlled trial

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UKADS Study Group (Including: Bellary, S., O'Hare, J. Paul, Raymond, Neil T., Gumber, Anil, Mughal, S., Szczepura, Ala, Kumar, Sudhesh and Barnett, A. H.). (2008) Effectiveness of enhanced diabetes care to patients of South Asian ethnicity : the United Kingdom Asian Diabetes Study (UKADS) : a cluster randomised controlled trial. Lancet, Vol.371 (No.9626). pp. 1769-1776. ISSN 0140-6736

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Official URL: http://dx.doi.org/10.1016/S0140-6736(08)60764-3

Abstract

Background: Delivering high quality and evidence based healthcare to deprived sectors of the community is a major goal for society. We investigated the effectiveness of a culturally sensitive enhanced care package in UK general practice in improving cardiovascular risk factors in South Asian patients with type 2 diabetes.
Methods: 21 inner city practices were randomised to intervention (enhanced practice nurse time, link worker and diabetes specialist nurse support) (n=868) or control (standard care) (n=618) groups. Prescribing algorithms with clearly defined targets were provided for all practices. Main outcome measures comprised changes in blood pressure, total cholesterol and glycaemic control (HbA1c) after 2 years.
Findings: At baseline, groups were similar with respect to age, sex and cardiovascular risk factors.
Comparing treatment groups, after adjustment for confounders, and clustering, differences in diastolic blood pressure (1.91mmHg, P=0.0001) and mean arterial pressure (1.36mmHg, P=0.0180) were significant. There were no significant differences between groups for total cholesterol or HbA1c. Economic analysis indicates the nurse-led intervention was not cost-effective.
Across the whole study population systolic blood pressure, diastolic blood pressure and cholesterol decreased significantly by 4.9mmHg, 3.8mmHg and 0.45mmol/L respectively, but there was no change in HbA1c.
Interpretation: Additional, although limited, benefits were observed from our culturally enhanced care package over and above the secular changes achieved in the UK in recent years. Stricter targets in general practice and further measures to motivate patients are needed to maximise healthcare outcomes in South Asian patients with diabetes.

Item Type:

Journal Article

Alternative Title:

Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study) : a cluster randomised controlled trial

Subjects:

R Medicine > RC Internal medicine

Divisions:

Faculty of Medicine > Warwick Medical School

Library of Congress Subject Headings (LCSH):

Diabetes -- Treatment -- Great Britain, Asians -- Great Britain, Minorities -- Health and hygiene -- Great Britain

Journal or Publication Title:

Lancet

Publisher:

Elsevier

ISSN:

0140-6736

Official Date:

2008

Dates:

Date	Event
2008	Published

Volume:

Vol.371

Number:

No.9626

Page Range:

pp. 1769-1776

Identification Number:

10.1016/S0140-6736(08)60764-3

Status:

Peer Reviewed

Access rights to Published version:

Open Access

Description:

Version accepted by publisher (post-print, after peer review, before copy-editing).

Funder:

Pfizer Inc., Sanofi Aventis (Firm), Servier Laboratories UK, Schering-Plough Corporation, Takeda UK (Firm), Roche, Merck Pharma, Daiichi-Sankyo UK, Boehringer Ingelheim Pharmaceuticals, Eli Lilly International Foundation, Novo Nordisk, Bristol-Meyers Squibb, Solvay Health Care, Assurance Medical Society UK, Merck Sharp & Dohme

Related URLs:

Publisher

References:

1. Greenhalgh PM. Diabetes in British south Asians: nature, nurture, and culture. Diabet Med 1997; 14(1):10-18.
2. Barnett AH, Dixon AN, Bellary S et al. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia 2006; 49(10):2234-2246.
3. Mather HM, Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J (Clin Res Ed) 1985; 291(6502):1081-1084.
4. Chaturvedi N, Fuller JH. Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health 1996; 50(2):137-139.
5. Health Survey for England 2004:Health of Ethnic Minorities-Full Report. Date Accessed 21-2-2008.
6. Stone M, Pound E, Pancholi A, Farooqi A, Khunti K. Empowering patients with diabetes: a qualitative primary care study focusing on South Asians in Leicester, UK. Fam Pract 2005; 22(6):647-652.
7. Shekelle P. New contract for general practitioners. BMJ 2003; 326(7387):457-458.
8. Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care 2002; 25(2):259-268.
9. Gammon BD, Gunarathne A. It's time to reappraise recruitment of South Asians to clinical trials. BMJ 2008; 336(7634):46.
10. Campbell M, Fitzpatrick R, Haines A et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000; 321(7262):694-696.
11. O'Hare JP., Raymond NT, Mughal S et al. Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS). Diabet Med 2004; 21(12):1357-1365.
12. Summary of revisions for the 2007 clinical practice recommendations. Diabetes Care 2007; 30 Suppl 1:S3.
13. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289(19):2560-2572.
14. Grundy SM, Cleeman JI, Merz CN et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110(2):227-239.
15. Perera R, Heneghan C, Yudkin P. Graphical method for depicting randomised trials of complex interventions. BMJ 2007; 334(7585):127-129.
- 25 -
16. Anderson KM, Wilson PW, Odell PM, Kannel WB. An updated coronary risk profile. A statement for health professionals. Circulation 1991; 83(1):356-362.
17. Smeeth L, Ng ES. Intraclass correlation coefficients for cluster randomized trials in primary care: data from the MRC Trial of the Assessment and Management of Older People in the Community. Control Clin Trials 2002; 23(4):409-421.
18. Underwood M, Barnett A, Hajioff S. Cluster randomization: a trap for the unwary. Br J Gen Pract 1998; 48(428):1089-1090.
19. Singer JD. Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. J Educational & Behavioural Statistics 1998; 24:323-355.
20. Sullivan LM, Dukes KA, Lofina E. Tutorial in biostatistics: an introduction to hierarchical linear modelling. Stat Med 1999; 18:855-888.
21. Dolan PG, Kind P, Williams A. A social tariff for EuroQol: results from a UK general population survey. 1995. Centre for Health Economics, University of York, 1995.
22. Williams B, Poulter NR, Brown MJ et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004; 18(3):139-185.
23. Collins R, MacMahon S. Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 1994; 50(2):272-298.
24. Gueyffier F, Boutitie F, Boissel JP et al. Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators. Ann Intern Med 1997; 126(10):761-767.
25. Hansson L, Zanchetti A, Carruthers SG et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351(9118):1755-1762.
26. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360(9349):1903-1913.
27. Khunti K, Gadsby R, Millett C, Majeed A, Davies M. Quality of diabetes care in the UK: comparison of published quality-of-care reports with results of the Quality and Outcomes Framework for Diabetes. Diabet Med 2007; 24(12):1436-1441.
28. Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355(9200):253-259.
- 26 -
29. Wright A, Burden AC, Paisey RB, Cull CA, Holman RR. Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57). Diabetes Care 2002; 25(2):330-336.
30. Davies MJ, Heller S, Skinner TC et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ 2008.
31. Raftery J. NICE: faster access to modern treatments? Analysis of guidance on health technologies. BMJ 2001; 323(7324):1300-1303.
32. Hunt S, Bhopal R. Self reports in research with non-English speakers. BMJ 2003; 327(7411):352-353.
33. Hussain-Gambles M, Leese B, Atkin K, Brown J, Mason S, Tovey P. Involving South Asian patients in clinical trials. Health Technol Assess 2004; 8(42):iii, 1-iii109.
34. Saxena S, Misra T, Car J, Netuveli G, Smith R, Majeed A. Systematic review of primary healthcare interventions to improve diabetes outcomes in minority ethnic groups. J Ambul Care Manage 2007; 30(3):218-230.