Lim, Lee-Ling and Lau, Eric S. H. and Fu, Amy W. C. and Ray, Subir and Hung, Yi-Jen and Tan, Alexander T. B. and Chamnan, Parinya and Sheu, Wayne H. H. and Chawla, Manoj S. and Chia, Yook-Chin and Chuang, Lee-Ming and Nguyen, Duc-Cong and Sosale, Aravind and Saboo, Banshi D. and Phadke, Uday and Kesavadev, Jothydev and Goh, Su-Yen and Gera, Neeru and Vu, Thi Thanh Huyen and Ma, Ronald C. W. and Lau, Vanessa and Luk, Andrea O. Y. and Kong, Alice P. S. and Chan, Juliana C. N. and Grp, Asia-Pacific JADE Study (2021) Effects of a technology-assisted integrated diabetes care program on cardiometabolic risk factors among patients with type 2 diabetes in the Asia-Pacific region the JADE program randomized clinical trial. JAMA Network Open, 4 (4). ISSN 2574-3805, DOI https://doi.org/10.1001/jamanetworkopen.2021.7557.
Full text not available from this repository.Abstract
Question What are the effects of a quality improvement intervention on the care and cardiometabolic risk factors of patients with type 2 diabetes in low- and middle-income countries in the Asia-Pacific region? Findings In this randomized clinical trial of 20 834 patients with type 2 diabetes in 8 Asia-Pacific countries, the intervention group received a technology-guided structured evaluation, automated personalized reports to encourage patient empowerment, and nurse reminders to increase patient engagement over a 12-month period. Clinical events were similar between the control and intervention groups at 12 months; however, the intervention group was more likely to experience reductions in multiple risk factors and increases in the attainment of diabetes-associated targets. Meaning The study's findings indicate that the use of information and communications technology and nurses to empower and engage patients did not change the number of clinical events but did reduce cardiometabolic risk factors among patients with type 2 diabetes in low- and middle-income countries. Importance Many health care systems lack the efficiency, preparedness, or resources needed to address the increasing number of patients with type 2 diabetes, especially in low- and middle-income countries. Objective To examine the effects of a quality improvement intervention comprising information and communications technology and contact with nonphysician personnel on the care and cardiometabolic risk factors of patients with type 2 diabetes in 8 Asia-Pacific countries. Design, Setting, and Participants This 12-month multinational open-label randomized clinical trial was conducted from June 28, 2012, to April 28, 2016, at 50 primary care or hospital-based diabetes centers in 8 Asia-Pacific countries (India, Indonesia, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam). Six countries were low and middle income, and 2 countries were high income. The study was conducted in 2 phases; phase 1 enrolled 7537 participants, and phase 2 enrolled 13 297 participants. Participants in both phases were randomized on a 1:1 ratio to intervention or control groups. Data were analyzed by intention to treat and per protocol from July 3, 2019, to July 21, 2020. Interventions In both phases, the intervention group received 3 care components: a nurse-led Joint Asia Diabetes Evaluation (JADE) technology-guided structured evaluation, automated personalized reports to encourage patient empowerment, and 2 or more telephone or face-to-face contacts by nurses to increase patient engagement. In phase 1, the control group received the JADE technology-guided structured evaluation and automated personalized reports. In phase 2, the control group received the JADE technology-guided structured evaluation only. Main Outcomes and Measures The primary outcome was the incidence of a composite of diabetes-associated end points, including cardiovascular disease, chronic kidney disease, visual impairment or eye surgery, lower extremity amputation or foot ulcers requiring hospitalization, all-site cancers, and death. The secondary outcomes were the attainment of 2 or more primary diabetes-associated targets (glycated hemoglobin A(1c) <7.0%, blood pressure <130/80 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL) and/or 2 or more key performance indices (reduction in glycated hemoglobin A(1c)>= 0.5%, reduction in systolic blood pressure >= 5 mm Hg, reduction in low-density lipoprotein cholesterol >= 19 mg/dL, and reduction in body weight >= 3.0%). Results A total of 20 834 patients with type 2 diabetes were randomized in phases 1 and 2. In phase 1, 7537 participants (mean SD] age, 60.0 11.3] years; 3914 men 51.9%]; 4855 patients 64.4%] from low- and middle-income countries) were randomized, with 3732 patients allocated to the intervention group and 3805 patients allocated to the control group. In phase 2, 13 297 participants (mean SD] age, 54.0 11.1] years; 7754 men 58.3%]; 13 297 patients 100%] from low- and middle-income countries) were randomized, with 6645 patients allocated to the intervention group and 6652 patients allocated to the control group. In phase 1, compared with the control group, the intervention group had a similar risk of experiencing any of the primary outcomes (odds ratio OR], 0.94; 95% CI, 0.74-1.21) but had an increased likelihood of attaining 2 or more primary targets (OR, 1.34; 95% CI, 1.21-1.49) and 2 or more key performance indices (OR, 1.18; 95% CI, 1.04-1.34). In phase 2, the intervention group also had a similar risk of experiencing any of the primary outcomes (OR, 1.02; 95% CI, 0.83-1. 25) and had a greater likelihood of attaining 2 or more primary targets (OR, 1.25; 95% CI, 1.14-1.37) and 2 or more key performance indices (OR, 1.50; 95% CI, 1.33-1.68) compared with the control group. For attainment of 2 or more primary targets, larger effects were observed among patients in low- and middle-income countries (OR, 1.50; 95% CI, 1.29-1.74) compared with high-income countries (OR, 1.20; 95% CI, 1.03-1.39) (P = .04). Conclusions and Relevance In this 12-month clinical trial, the use of information and communications technology and nurses to empower and engage patients did not change the number of clinical events but did reduce cardiometabolic risk factors among patients with type 2 diabetes, especially those in low- and middle-income countries in the Asia-Pacific region. This randomized clinical trial examines the effects of a quality improvement intervention comprising information and communications technology and increased contact with nurses on the clinical care and cardiometabolic risk factors of patients with type 2 diabetes in Asia-Pacific countries.
| Item Type: | Article |
|---|---|
| Funders: | Merck & Company |
| Uncontrolled Keywords: | Cardiometabolic risk factors;Health care systems;Diabetes |
| Subjects: | R Medicine R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms Zaharah Ramly |
| Date Deposited: | 31 May 2022 07:57 |
| Last Modified: | 31 May 2022 07:57 |
| URI: | http://eprints.um.edu.my/id/eprint/34635 |
Actions (login required)
 |
View Item |
