Effectiveness of enhanced diabetes care to patients of South Asian ethnicity : the United Kingdom Asian Diabetes Study (UKADS) : a cluster randomised controlled trial
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
WRAP_Sczepura_Manuscript-UKADS-Lancet-Final-18Mar2008.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Official URL: http://dx.doi.org/10.1016/S0140-6736(08)60764-3
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|
|Page Range:||pp. 1769-1776|
|Access rights to Published version:||Open Access|
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|
1. Greenhalgh PM. Diabetes in British south Asians: nature, nurture, and culture. Diabet Med 1997; 14(1):10-18.
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