A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes
G E Tutino, W Y Yang, X Li, W H Li, Y Y Zhang, X H Guo, A O Luk, R O P Yeung, J M Yin, R Ozaki, W Y So, R C W Ma, L N Ji, A P S Kong, J P Weng, G T C Ko, W P Jia, J C N Chan, China JADE Study Group, Yu Zhu, Xiaoping Xing, Fan Ping, Junqing Zhang, Xiaowei Ma, Jing Hong, Xuhong Hou, Yanhua Zhu, G E Tutino, W Y Yang, X Li, W H Li, Y Y Zhang, X H Guo, A O Luk, R O P Yeung, J M Yin, R Ozaki, W Y So, R C W Ma, L N Ji, A P S Kong, J P Weng, G T C Ko, W P Jia, J C N Chan, China JADE Study Group, Yu Zhu, Xiaoping Xing, Fan Ping, Junqing Zhang, Xiaowei Ma, Jing Hong, Xuhong Hou, Yanhua Zhu
Abstract
Aims: To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour.
Methods: The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l).
Results: Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001).
Conclusions: Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).
© 2016 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
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References
- Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383–93.
- Gaede P, Lund‐Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358: 580–591.
- Kong AP, Yang X, Ko GT, So WY, Chan WB, Ma RC et al Effects of treatment targets on subsequent cardiovascular events in Chinese patients with type 2 diabetes. Diabetes Care 2007; 30: 953–959.
- Gaede P, Valentine WJ, Palmer AJ, Tucker DM, Lammert M, Parving HH et al Cost‐effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno‐2 study. Diabetes Care 2008; 31: 1510–1515.
- Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA et al Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–12.
- Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999‐2010. N Engl J Med 2013; 368: 1613–1624.
- Cheng XB, Hsieh YT, Tu ST, Hsieh MC. Obesity and low target attainment rates in Chinese with type 2 diabetes. Eur J Intern Med 2012; 23: e101–105.
- Wang HH, Wang JJ, Wong SY, Wong MC, Mercer SW, Griffiths SM. The development of urban community health centres for strengthening primary care in China: A systematic literature review. Br Med Bull 2015; 116: 139–154.
- Chan JCN, Cockram CS. Organisation of diabetes care – Western Pacific Region (Hong Kong and China as examples) In: DeFronzo A, Feranninni E, Keen H, Zimmet P. eds. International textbook of diabetes mellitus. Oxford: John, Wiley & Son, 2004.
- Institute of Medicine . Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.
- Tricco AC, Ivers NM, Grimshaw JM, Moher D, Turner L, Galipeau J et al Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta‐analysis. Lancet 2012; 379: 2252–2261.
- Wu JY, Leung WY, Chang S, Lee B, Zee B, Tong PC et al Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ 2006; 333: 522.
- Chan JCN, So WY, Yeung CY, Ko GTC, Lau IT, Tsang MW et al The SURE Study: Effects of Structured versus Usual care on Renal Endpoint in Type 2 diabetes: A randomized multi‐centre translational study. Diabetes Care 2009; 32: 977–982.
- Chan JCN, So WY, Ko G, Tong PCT, Yang XL, Ma RCW et al The Joint Asia Diabetes Evaluation (JADE) Program: A Web‐based Program to Translate Evidence to Clinical Practice in Type 2 Diabetes. Diabet Med 2009; 26: 693–699.
- Ko GT, So WY, Tong PC, Le Coguiec F, Kerr D, Lyubomirsky G et al From design to implementation–the Joint Asia Diabetes Evaluation (JADE) program: a descriptive report of an electronic web‐based diabetes management program. BMC Med Inform Decis Mak 2010; 10: 26.
- Yang X, So WY, Kong AP, Ho CS, Lam CW, Stevens RJ et al Development and validation of stroke risk equation for Hong Kong Chinese patients with type 2 diabetes: the Hong Kong Diabetes Registry. Diabetes Care 2007; 30: 65–70.
- Yang X, So WY, Kong AP, Ma RC, Ko GT, Ho CS et al Development and validation of a total coronary heart disease risk score in type 2 diabetes mellitus. Am J Cardiol 2008; 101: 596–601.
- Yang XL, So WY, Kong AP, Ho CS, Lam CW, Ng MH et al Modified end‐stage renal disease risk score for Chinese type 2 diabetic patients—the Hong Kong Diabetes Registry. Diabetologia 2007; 50: 1348–1350.
- Yang X, Ma RC, So WY, Kong AP, Ko GT, Ho CS et al Development and validation of a risk score for hospitalization for heart failure in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2008; 7: 9.
- So WY, Tong PC, Ko GT, Leung WY, Chow CC, Yeung VT et al Effects of protocol‐driven care versus usual outpatient clinic care on survival rates in patients with type 2 diabetes. Am J Manag Care 2003; 9: 606–615.
- Chan JC, Sui Y, Oldenburg B, Zhang Y, Chung HH, Goggins W et al Effects of telephone‐based peer support in patients with type 2 diabetes mellitus receiving integrated care: a randomized clinical trial. JAMA Intern Med 2014; 174: 972–981.
- Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ et al Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta‐regression analysis. JAMA 2006; 296: 427–440.
- Ko GT, Li JK, Kan EC, Lo MK. Effects of a structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese Type 2 diabetic patients: a 1‐year prospective randomized study. Diabet Med 2004; 21: 1274–1279.
- Tien KJ, Hung HC, Hsiao JY, Hsu SC, Hsin SC, Shin SJ et al Effectiveness of comprehensive diabetes care program in Taiwanese with type 2 diabetes. Diabetes Res Clin Pract 2008; 79: 276–283.
- Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self‐management education for adults with type 2 diabetes: a meta‐analysis of the effect on glycemic control. Diabetes Care 2002; 25: 1159–1171.
- Beverly EA, Fitzgerald SM, Brooks KM, Hultgren BA, Ganda OP, Munshi M et al Impact of reinforcement of diabetes self‐care on poorly controlled diabetes: a randomized controlled trial. Diabetes Educ 2013; 39: 504–514.
- Garcıa‐Perez LE, Alvarez M, Dilla T, Gil‐Guillen V, Orozco‐Beltran D. Adherence to Therapies in Patients with Type 2 Diabetes. Diabetes Ther 2013; 4: 175–194.
- Currie CJ, Peyrot M, Morgan CL, Poole CD, Jenkins‐Jones S, Rubin RR et al The impact of treatment noncompliance on mortality in people with type 2 diabetes. Diabetes Care 2012; 35: 1279–1284.
- Asche C, LaFleur J, Conner C. A Review of Diabetes Treatment Adherence and the Association with Clinical and Economic Outcomes. Clin Ther 2011; 33: 74–109.
- Karter AJ, Parker MM, Moffet HH, Ahmed AT, Ferrara A, Liu JY et al Missed appointments and poor glycemic control: an opportunity to identify high‐risk diabetic patients. Med Care 2004; 42: 110–115.
Source: PubMed