Difference in mean utility for selected complications (grouped by 4 classes of algorithms)

<p><b>Copyright information:</b></p><p>Taken from "Which health-related quality of life score? A comparison of alternative utility measures in patients with Type 2 diabetes in the ADVANCE trial"</p><p>http://www.hqlo.com/content/5/1/21</p><p>Health and Quality of Life Outcomes 2007;5():21-21.</p><p>Published online 27 Apr 2007</p><p>PMCID:PMC1950473.</p><p></p

Mean deficit (and 95% CIs) in utility value at study baseline for patients with selected medical condition

<p><b>Copyright information:</b></p><p>Taken from "Which health-related quality of life score? A comparison of alternative utility measures in patients with Type 2 diabetes in the ADVANCE trial"</p><p>http://www.hqlo.com/content/5/1/21</p><p>Health and Quality of Life Outcomes 2007;5():21-21.</p><p>Published online 27 Apr 2007</p><p>PMCID:PMC1950473.</p><p></p

Cardiovascular risk profile of statin-naïve adults aged 40–75 years without existing cardiovascular disease (CVD) and at moderate and high risk of CVD in the US using NHANES (2007–2012), and in England using HSE (2009–2013).

<p>Cardiovascular risk profile of statin-naïve adults aged 40–75 years without existing cardiovascular disease (CVD) and at moderate and high risk of CVD in the US using NHANES (2007–2012), and in England using HSE (2009–2013).</p

Distribution of 10 year CVD risk in currently statin-naïve US and English population aged 40–75 years at moderate or high risk of CVD.

<p>The dotted grey line represents the current risk distribution in the population; the dotted orange line represents the risk distribution that would be achieved from treating both moderate- and high-risk individuals with statins; and the blue line shows the risk distribution if individuals with high CVD risk were treated with statins. Area A represents the risk reduction achieved from treatment of statin-naïve individuals at moderate risk; area B represents the risk reduction that could be achieved from treatment of statin-naïve individuals at high-risk. Moderate risk is ≥7.5% to <20% in the US, and ≥10% to <20% in England. High risk is ≥20% in both countries.</p

Cardiovascular risk profile of adults aged 40–75 years without existing cardiovascular disease (CVD) and at moderate and high risk of CVD in England using HSE (2009–2013) and in the US using NHANES (2007–2012).

<p>Cardiovascular risk profile of adults aged 40–75 years without existing cardiovascular disease (CVD) and at moderate and high risk of CVD in England using HSE (2009–2013) and in the US using NHANES (2007–2012).</p

GP-OSMOTIC trial protocol: an individually randomised controlled trial to determine the effect of retrospective continuous glucose monitoring (r-CGM) on HbA1c in adults with type 2 diabetes in general practice.

INTRODUCTION: Optimal glycaemia can reduce type 2 diabetes (T2D) complications. Observing retrospective continuous glucose monitoring (r-CGM) patterns may prompt therapeutic changes but evidence for r-CGM use in T2D is limited. We describe the protocol for a randomised controlled trial (RCT) examining intermittent r-CGM use (up to 14 days every three months) in T2D in general practice (GP). METHODS AND ANALYSIS: General Practice Optimising Structured MOnitoring To achieve Improved Clinical Outcomes is a two-arm RCT asking 'does intermittent r-CGM in adults with T2D in primary care improve HbA1c?' PRIMARY OUTCOME: Absolute difference in mean HbA1c at 12 months follow-up between intervention and control arms. SECONDARY OUTCOMES: (a) r-CGM per cent time in target (4-10 mmol/L) range, at baseline and 12 months; (b) diabetes-specific distress (Problem Areas in Diabetes). ELIGIBILITY: Aged 18-80 years, T2D for ≥1 year, a (past month) HbA1c>5.5 mmol/mol (0.5%) above their individualised target while prescribed at least two non-insulin hypoglycaemic therapies and/or insulin (therapy stable for the last four months). Our general glycaemic target is 53 mmol/mol (7%) (patients with a history of severe hypoglycaemia or a recorded diagnosis of hypoglycaemia unawareness will have a target of 64 mmol/mol (8%)).Our trial compares r-CGM use and usual care. The r-CGM report summarising daily glucose patterns will be reviewed by GP and patient and inform treatment decisions. Participants in both arms are provided with 1 hour education by a specialist diabetes nurse.The sample (n=150/arm) has 80% power to detect a mean HbA1c difference of 5.5 mmol/mol (0.5%) with an SD of 14.2 (1.3%) and alpha of 0.05 (allowing for 10% clinic and 20% patient attrition). ETHICS AND DISSEMINATION: University of Melbourne Human Ethics Sub-Committee (ID 1647151.1). Dissemination will be in peer-reviewed journals, conferences and a plain-language summary for participants. TRIAL REGISTRATION NUMBER: >ACTRN12616001372471; Pre-results

Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis

OBJECTIVE The implementation of the Chronic Care Model (CCM) improves health care quality. We examined the sustained effectiveness of multicomponent integrated care in type 2 diabetes. RESEARCH DESIGN AND METHODS We searched PubMed and OvidMEDLINE (January 2000-August 2016) and identified randomized controlled trials comprising two or more quality improvement strategies from two or more domains (health system, health care providers, or patients) lasting ≥12 months with one or more clinical outcomes. Two reviewers extracted data and appraised the reporting quality. RESULTS In a meta-analysis of 181 trials (N = 135,112), random-effects modeling revealed pooledmean differences in HbA1c of20.28%(95%CI20.35 to20.21) (23.1mmol/mol [23.9 to 22.3]), in systolic blood pressure (SBP) of 22.3 mmHg (23.1 to 21.4), in diastolic blood pressure (DBP) of 21.1 mmHg (21.5 to 20.6), and in LDL cholesterol (LDL-C) of 20.14 mmol/L (20.21 to 20.07), with greater effects in patients with LDL-C ≥3.4 mmol/L (20.31 vs. 20.10 mmol/L for 12 months (SBP 23.4 vs. 21.4 mmHg, Pdifference = 0.034; DBP 21.7 vs. 20.7 mmHg, Pdifference = 0.047; LDL-C 20.21 vs. 20.07 mmol/L for 12-month studies, Pdifference = 0.049). Patients with median age <60 years had greater HbA1c reduction (20.35% vs. 20.18% for ≥60 years [23.8 vs. 22.0 mmol/mol]; Pdifference = 0.029). Team change, patient education/self-management, and improved patient-provider communication had the largest effect sizes (0.28-0.36% [3.0-3.9 mmol/mol]). CONCLUSIONS Despite the small effect size of multicomponent integrated care (in part attenuated by good background care), team-based care with better information flow may improve patient-provider communication and self-management in patients who are young, with suboptimal control, and in low-resource settings