The Microalbuminuria Education Medication and Optimisation (MEMO) study: 4 years follow-up of multifactorial intervention in high-risk individuals with type 2 diabetes.

Abstract

The Microalbuminuria Education Medication and Optimisation (MEMO) study, revealed improved cardiovascular risk and glycaemic control with 18months of intensive multifactorial intervention in high-risk people with type 2 diabetes, without any increase in severe hypoglycaemia. Our aim was to assess longer-term outcomes at 4-year follow-up in these participants. Some 189 individuals with type 2 diabetes and microalbuminuria were recruited from a multi-ethnic population in Leicestershire, UK. The intervention group (n=95) received multifactorial intervention with self-management education, and the control group (n=94) received usual care. The primary outcome was change in HbA1c , and secondary outcomes were blood pressure (BP), cholesterol, microalbuminuria, estimated GFR, cardiovascular risk scores and major adverse cardiovascular events. Some 130 participants (68.7%), mean (sd) age 60.8 (10.4) years, duration of diabetes 11.5 (9.7) years, completed 4years of follow-up. Mean change [95% confidence intervals (CI)] in HbA1c over 4years was greater with intensive intervention compared with control (-3mmol/mol, 95% CI -4.95,-1.11; -0.4%, 95% CI -0.67,-0.15; P=0.002). Significant improvements over the 4years were also seen in systolic BP (-7.3mmHg, 95% CI -11.1, -3.5; P<0.001), diastolic BP (-2.9mmHg, 95% CI -5.4, -0.3; P=0.026), cholesterol (-0.3mmol/l, 95% CI -0.52,-0.12; P=0.002), and 10-year coronary heart disease (-5.3, 95% CI -8.2,-2.3; P<0.001) and stroke risk (-4.4, 95% CI -7.5, -1.3; P<0.001). Multifactorial intervention with structured diabetes self-management education compared with usual diabetes care has benefits for cardio-metabolic risk factor profile. There was no increase in severe hypoglycaemia and cardiovascular mortality despite intensive glycaemic control, although the study was not powered to assess these outcomes.