The GIANT study, a cluster-randomised controlled trial of efficacy of education of doctors about type 2 diabetes mellitus management guidelines in primary care practice

• Published in: Diabetes research and clinical practice Vol. 98; no. 1; pp. 38 - 45
• Main Authors: Reutens, Anne T, Hutchinson, Richard, Van Binh, Ta, Cockram, Clive, Deerochanawong, Chaicharn, Ho, Low-Tone, Ji, Linong, Khalid, Bin Abdul Kadir, Kong, Alice Pik Shan, Lim-Abrahan, Mary Ann, Tan, Chee-Eng, Tjokroprawiro, Askandar, Yoon, Kun-Ho, Zimmet, Paul Z, Shaw, Jonathan E
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.10.2012
• Subjects: Adult; Asia - epidemiology; Asia-Pacific; Blood Glucose - metabolism; Cardiovascular Diseases - blood; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - epidemiology; Cluster Analysis; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Angiopathies - blood; Diabetic Angiopathies - drug therapy; Diabetic Angiopathies - epidemiology; Education, Medical, Continuing; Endocrinology & Metabolism; Female; Follow-Up Studies; General Practitioners - education; General Practitioners - statistics & numerical data; Glycaemic control; Glycated Hemoglobin A - metabolism; Guideline Adherence; Humans; Male; Middle Aged; Pacific Islands - epidemiology; Practice guidelines; Practice Guidelines as Topic; Primary care; Primary Health Care - standards; Primary Health Care - statistics & numerical data; Risk Factors; Type 2 diabetes; general practitioner; Type 2 diabetes; blood pressure; GP; IDF; Western Pacific Region; Primary care; BP; Asia-Pacific; SD; WPR; Practice guidelines; FPG; fasting plasma glucose; HbA1c; glycated haemoglobin; Glycaemic control; International Diabetes Federation; standard deviation
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2012.06.002

Abstract Objectives Primary aim: does general practitioner (GP) education on type 2 diabetes treatment improve HbA1c? Secondary aim: cardiovascular risk factors, hypoglycaemia, treatment intensification, health service utilisation, treatment barriers. Methods 99 Asia-Pacific GPs were cluster-randomised to be educated on regional diabetes management guidelines (intervention) or continue standard care (control). The intervention employed meetings, reminders, medical record summary sheets and patient result cards. Each GP recruited four type 2 diabetic patients, assessed at baseline, 6 and 12 months. The primary outcome was mean change in HbA1c from 0 to 6 months in patients with baseline HbA1c ≥ 6.5%. Results 361 patients (93%) completed 6 month follow-up. The primary HbA1c outcome was −0.11% (95% CI −0.27, 0.05) with intervention and −0.22% (95% CI −0.39, −0.05) in the control group ( p = 0.340). The groups did not differ in control of other glycaemic indices, blood pressure or lipids after 6 or 12 months. In those with HbA1c ≥ 9.0%, approximately 50% received intensified treatment by 6 months, and 30% in the final 6 months. GPs identified treatment costs and patient reluctance to use insulin as management barriers. Conclusions/interpretation A structured GP education programme did not improve HbA1c in patients with type 2 diabetes.