Publication Type:

Journal Article


Ann Intern Med, Volume 165, Issue 6, p.399-408 (2016)


<p><b>BACKGROUND: </b>Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia.</p><p><b>OBJECTIVE: </b>To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes.</p><p><b>DESIGN: </b>Parallel, open-label, pragmatic randomized, controlled trial. ( NCT01212328).</p><p><b>SETTING: </b>Diabetes clinics in India and Pakistan.</p><p><b>PATIENTS: </b>1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL).</p><p><b>INTERVENTION: </b>Multicomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records.</p><p><b>MEASUREMENTS: </b>Proportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, health-related quality of life (HRQL), and treatment satisfaction (secondary outcomes).</p><p><b>RESULTS: </b>Baseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7 mm Hg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction.</p><p><b>LIMITATION: </b>Findings were confined to urban specialist diabetes clinics.</p><p><b>CONCLUSION: </b>Multicomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics.</p><p><b>PRIMARY FUNDING SOURCE: </b>National Heart, Lung, and Blood Institute and UnitedHealth Group.</p>

Cite this Research Publication

M. K. Ali, Singh, K., Kondal, D., Devarajan, R., Patel, S. A., Shivashankar, R., Ajay, V. S., Unnikrishnan, A. G., V Menon, U., Varthakavi, P. K., Viswanathan, V., Dharmalingam, M., Bantwal, G., Sahay, R. Kumar, Masood, M. Qamar, Khadgawat, R., Desai, A., Sethi, B., Prabhakaran, D., Narayan, K. M. Venkat, and Tandon, N., “Effectiveness of a Multicomponent Quality Improvement Strategy to Improve Achievement of Diabetes Care Goals: A Randomized, Controlled Trial.”, Ann Intern Med, vol. 165, no. 6, pp. 399-408, 2016.