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Trial registered on ANZCTR


Registration number
ACTRN12612000380897
Ethics application status
No
Date submitted
2/04/2012
Date registered
3/04/2012
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
A randomised trial of a novel model of diabetes care for adults in the community through multidisciplinary collaboration and integration across the primary and tertiary interface
Scientific title
Comparison of a novel model of community care versus usual care on glycaemic control in adults with type 2 diabetes: a randomised trial
Secondary ID [1] 280100 0
nil
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Type 2 diabetes 286013 0
Condition category
Condition code
Metabolic and Endocrine 286201 286201 0 0
Diabetes
Public Health 286431 286431 0 0
Health service research

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
This intervention is based on a novel concept which incorporates the principle of General Practitioners (GPs) with special interests around a multidisciplinary and coordinated approach to diabetes care in the community. This model of care includes a specialist doctor (endocrinologist), who acts in a consulting capacity to the GP, to endorse the GPs patient management plan. The intervention is delivered face to face with their advanced GP as well as with a diabetes nurse educator. This intervention will include follow up appointments which will be approximately every 6 weeks and will continue until 12 months.
Intervention code [1] 284425 0
Treatment: Other
Comparator / control treatment
Usual care for patients with complex type 2 diabetes is in an endocrinology and diabetes outpatients settings at a secondary or tertiary hospital. Typically patient care is delivered prodominantly by a consultant doctor (an endocrinologist).
Control group
Active

Outcomes
Primary outcome [1] 286675 0
glycaemic control (as measured by HbA1c)
Timepoint [1] 286675 0
6 months
12 months
Secondary outcome [1] 296480 0
blood pressure
Timepoint [1] 296480 0
6 months
12 months
Secondary outcome [2] 296885 0
cholesterol and cholesterol fractions
Timepoint [2] 296885 0
6 months
12 months
Secondary outcome [3] 296886 0
Body mass index
Timepoint [3] 296886 0
6 months
12 months
Secondary outcome [4] 296887 0
proportion of patients ceased smoking, collected by patient self-report on questionnaire
Timepoint [4] 296887 0
6 months
12 months
Secondary outcome [5] 296888 0
foot complications including presence of diabetic ulcers/sores, partial or total foot amputation, charcot joint, delayed healing times for injured skin, neuropathic symptoms, pulses present in right and left foot (determined by assessment from podiatrist)
Timepoint [5] 296888 0
6 months
12 months
Secondary outcome [6] 296889 0
retinopathy complications (determined by retinal photography taken by diabetic nurse educator and assessed by Endocrinologist)
Timepoint [6] 296889 0
6 months
12 months
Secondary outcome [7] 296890 0
microalbuminuria (determined by urine analysis to calculate albumuria to creatinine ratio and compared to reference range)
Timepoint [7] 296890 0
6 months
12 months
Secondary outcome [8] 296891 0
serum creatinine
Timepoint [8] 296891 0
6 months
12 months
Secondary outcome [9] 296892 0
hospitalisations for diabetic related complications (determined by data linkage to external database Queensland Hospital Admitted Patients Data Collection (QHAPDC))
Timepoint [9] 296892 0
6 months
12 months
Secondary outcome [10] 296893 0
proportion of patients achieving clinical target for HbA1c (at less than or equal to 7%) measured by blood pathology testing
Timepoint [10] 296893 0
6 months
12 months
Secondary outcome [11] 296894 0
proportion of patients achieving clinical target for blood pressure (at less than or equal to 130/80 mm/Hg) measured in seated position with digital sphygmomanometer
Timepoint [11] 296894 0
6 months
12 months
Secondary outcome [12] 296895 0
proportion of patients achieving clinical target for low density lipoprotein (at less than or equal to 2.5 mmol/L) measured by blood pathology testing
Timepoint [12] 296895 0
6 months
12 months

Eligibility
Key inclusion criteria
greater than 18 years
type 2 diabetes
referred to secondary/tertiary hospital diabetes outpatients for care
residing in the geographical area of interest in Brisbane, Australia
able to provide informed consent
Minimum age
18 Years
Maximum age
No limit
Gender
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
patients without hypoglycaemic awareness
pregnancy
receiving haemodialysis
patients with terminal illness with life expectancy less than 2 years

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The person who determines if a patient is eligible to participate is unaware of the allocation group at the time of enrolment. Randomisation to group is conducted after eligibility is confirmed and consent has been provided from the patient.

Allocation to treatment group is done off site by the study statistician who is removed from the screening of participants.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomisation will use a weighted control of 2 intervention to 1 control. The randomisation will be done via web based computer randomisation, which is set up by the study statistician remotely.
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
multi site
Phase
Not Applicable
Type of endpoint(s)
Efficacy
Statistical methods / analysis

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment outside Australia
Country [1] 289654 0
State/province [1] 289654 0

Funding & Sponsors
Funding source category [1] 284856 0
Government funding body e.g. Australian Research Council
Name [1] 284856 0
National Health and Medical Research Council
Address [1] 284856 0
National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
Country [1] 284856 0
Australia
Primary sponsor type
Individual
Name
Professor Claire Jackson
Address
Discipline of General Practice
School of Medicine
The University of Queensland
Level 8, Health Science Building
Royal Brisbane and Women's Hospital
Herston QLD 4029
Country
Australia
Secondary sponsor category [1] 283735 0
Individual
Name [1] 283735 0
Associate Professor Anthony Russell
Address [1] 283735 0
Department of Diabetes and Endocrinology
Princess Alexandra Hospital
199 Ipswich Road
Woolloongabba QLD 4102
Country [1] 283735 0
Australia

Ethics approval
Ethics application status
No
Ethics committee name [1] 287033 0
Ethics committee address [1] 287033 0
Ethics committee country [1] 287033 0
Date submitted for ethics approval [1] 287033 0
12/04/2012
Approval date [1] 287033 0
Ethics approval number [1] 287033 0

Summary
Brief summary
Diabetes is a chronic disease where the primary care physician has a central role to play. Historically, evidence has supported the role of diabetes teams in hospital settings being able to provide better care compared with primary care but it has been argued whether this relates to improved systematic and organised care, compared to increased expert knowledge. With appropriate support and recall systems, delivery of diabetes care in general practice can be as good as hospital outpatient care. Recognising this, the United Kingdom has seen the introduction of diabetes clinics conducted by general practitioners with special interests (GPSIs) with demonstrated favourable improvements in HbA1c, cholesterol and blood pressure. To date, Australia has not adopted GPSIs into clinical practice. However, the Australian health care system is facing significant reform aimed at shifting the focus from tertiary and secondary hospital health care to primary health care, including the move towards GP superclinics.

This research project focusses on the care of patients with complex T2DM who have been referred by their GPs for specialist diabetes care. This research is based on a novel concept which incorporates the principle of GPs with special interests around a multidisciplinary and coordinated approach to diabetes care in the community. Important to this model is the role of the specialist Endocrinologist in a consulting capacity to review and endorse the advanced skill GPs (GP Clinical Fellows) management plan. Few studies have investigated the staged devolution of diabetes services from secondary/tertiary care to primary care through increasing the capacity of primary care to meet the needs of patients who would otherwise use hospital outpatient services.
Trial website
Trial related presentations / publications
Askew DA, Jackson CL, Ware RS, Russell A. Protocol and baseline data from The Inala Chronic Disease
Management Service evaluation study: a health services intervention study for diabetes care. BMC Health Services
Research 2010;10:134.

Jackson, Claire, Tsai, Jane, Brown, Cathy, Askew, Deborah and Russell, Anthony (2010) GPs with special
interests impacting on complex diabetes care. Australian Family Physician, 39 12: 972974.
Public notes

Contacts
Principal investigator
Contact person for public queries
Contact person for scientific queries

No data has been provided for results reporting
Summary results
Not applicable