Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 10;24(1):183.
doi: 10.1186/s12902-024-01692-4.

Spillover effects from a type 2 diabetes integrated model of care in 22,706 Australians: an open cohort stepped wedge trial

Shamasunder Acharya  1   2   3 , Rachael Taylor  4   5 , Martha Parsons  6 , John Attia  6   4   5 , Lucy Leigh  5   7 , Christopher Oldmeadow  5   7 , Katie Wynne  6   4   5 , Christopher Rowe  6   4   5 , Morag Joseph  6   8 , Judy Luu  6   4 , Annalise Philcox  6   4 , Damien Jackel  6   4 , Tuan Quach  6   4 , Christy Sankoorikal  6   4 , Simone Dagg  6   4 , Alexis Hure  4   5
Affiliations

Spillover effects from a type 2 diabetes integrated model of care in 22,706 Australians: an open cohort stepped wedge trial

Shamasunder Acharya et al. BMC Endocr Disord. .

Abstract

Background: Many Australian adults are not receiving timely or effective diabetes management to prevent or delay the onset of diabetes related complications. Integrated care, a worldwide trend in healthcare reform, aims to reduce the fragmented delivery of health services and improve outcomes. This study aimed to test whether a specialist-led integrated model of care provided to a small subset of patients in general practices leads to spillover clinical improvements in all patients of the practice with type 2 diabetes.

Methods: Seventy-two general practice sites (clusters) in New South Wales, Australia received the Diabetes Alliance intervention, creating a non-randomised open cohort stepped wedge trial. The intervention comprised of case conferencing, delivered directly to a small proportion of adults with type 2 diabetes (n = 1,072) of the general practice sites; as well as practice feedback, education and training. Spillover clinical improvements were assessed on all adults with type 2 diabetes within the general practice sites (n = 22,706), using practice level data recorded in the MedicineInsight electronic database, compared before and after the intervention. Outcome measures included frequency of diabetes screening tests in line with the Annual Cycle of Care, and clinical results for weight, blood pressure, HbA1c, lipids, and kidney function.

Results: Compared to before Diabetes Alliance, the odds of all practice patients receiving screening tests at or above the recommended intervals were significantly higher for all recommended tests after Diabetes Alliance (odds ratio range 1.41-4.45, p < 0.0001). Significant improvements in clinical outcomes were observed for weight (absolute mean difference: -1.38 kg), blood pressure (systolic - 1.12 mmHg, diastolic - 1.18 mmHg), HbA1c (-0.03% at the mean), total cholesterol (-0.11 mmol/L), and triglycerides (-0.02 mmol/L) (p < 0.05). There were small but significant declines in kidney function.

Conclusions: Integrated care delivered to a small subset of patients with type 2 diabetes across a large geographic region has spillover benefits that improve the process measures and clinical outcomes for all practice patients with type 2 diabetes.

Trial registration: ACTRN12622001438741; 10th November 2022, retrospectively registered: https://www.anzctr.org.au/ACTRN12622001438741.aspx .

Keywords: Outcome assessment; Clinical trial; Diabetes mellitus; General practice; Health services; Type 2.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of recruitment of general practices and patients included in the analysis of de-identifiable data
Fig. 2
Fig. 2
Change in clinical outcome categories for systolic blood pressure, HbA1c and LDL-cholesterol before (light grey) and after (dark grey) Diabetes Alliance for patients with complete data
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843. 10.1016/j.diabres.2019.107843 - DOI - PubMed
    1. Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015—Summary report. Canberra, ACT 2019.
    1. Australian Institute of Health and Welfare (AIHW). Prevalence of self-reported type 2 diabetes, among persons aged 18 and over, 2017–18. Canberra, ACT AIHW; 2020.
    1. Baker IDI, Heart and Diabetes Institute. Diabetes: the silent pandemic and its impact on Australia. 2012.
    1. Bagheri N, McRae I, Konings P, Butler D, Douglas K, Del Fante P, et al. Undiagnosed diabetes from cross-sectional GP practice data: an approach to identify communities with high likelihood of undiagnosed diabetes. BMJ Open. 2014;4(7):e005305. 10.1136/bmjopen-2014-005305 - DOI - PMC - PubMed

Supplementary concepts

LinkOut - more resources