Abstract 17: Comparative Effectiveness of Implementation Strategies on Cardiovascular Risk Factor Control in Patients With Diabetes: The D4C Cluster Randomized Trial

Abstract

Objectives: Uncontrolled blood glucose, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) are major risk factors for premature death and cardiovascular disease (CVD) in patients with diabetes. We compared the effectiveness of team-based care (TBC) with clinical decision support systems (CDSS) versus TBC alone on CVD risk factor control among patients with diabetes in China. Methods: In the Diabetes Complication Control in Community Clinics (D4C) cluster randomized trial, 38 community health centers were randomly assigned to TBC-CDSS (primary care physician-health educator-diabetes specialist collaborative care plus guideline-based treatment protocol implemented in CDSS) or TBC alone in Xiamen City, China. A total of 11,132 patients (5378 in TBC-CDSS and 5754 in TBC) aged ≥50 years with uncontrolled diabetes and additional risk factors (dyslipidemia, hypertension, or clinical CVD) were recruited. The intervention lasted for 18 months, and study data were collected at 6, 12, and 18 months after baseline. Results: Mean baseline age (62.6 vs. 63.1 years), body mass index (24.9 vs. 24.9 kg/m 2 ), HbA1c (8.8 vs. 8.7%), LDL-C (121.2 vs. 121.1 mg/dL), systolic BP (136.6 vs. 136.9 mm Hg) and diastolic BP (79.7 vs. 79.8 mmHg) were comparable between TBC-CDSS and TBC alone groups. About 87.1% of participants in the TBC-CDSS group and 84.1% in the TBC alone group completed the 18-month intervention. Both TBC-CDSS and TBC alone significantly reduced HbA1c, LDL-C, and BP over the 18-month follow-up (all P<0.0001). Furthermore, the proportions of controlled HbA1c, LDL-C, and BP, as well as all 3 risk factors, were significantly higher in the TBC-CDSS group compared to the TBC alone group (Table). Conclusions: As compared with team-based care alone, team-based care plus a guideline-based treatment protocol implemented in clinical decision support systems further reduces CVD risk factors in patients with diabetes. (ClinicalTrials.gov number, NCT02835287)