Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta‐analysis of trials in primary care
Objective To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes. Search Strategy Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs). Inclusion Criteria...
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| Veröffentlicht in: | Health expectations : an international journal of public participation in health care and health policy 2017-12, Vol.20 (6), p.1218-1227 |
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| container_title | Health expectations : an international journal of public participation in health care and health policy |
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| creator | Dambha‐Miller, Hajira Cooper, Andrew J. M. Kinmonth, Ann Louise Griffin, Simon J. |
| description | Objective
To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.
Search Strategy
Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs).
Inclusion Criteria
RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care.
Data extraction and synthesis
We recorded if explicit theory‐based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL‐C) and HDL cholesterol (HDL‐C).
Results
We included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA1c levels (weighted mean difference, −0.53%; 95% CI: [−0.77, −0.28]; P |
| doi_str_mv | 10.1111/hex.12546 |
| format | Article |
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To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.
Search Strategy
Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs).
Inclusion Criteria
RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care.
Data extraction and synthesis
We recorded if explicit theory‐based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL‐C) and HDL cholesterol (HDL‐C).
Results
We included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA1c levels (weighted mean difference, −0.53%; 95% CI: [−0.77, −0.28]; P<.0001; I2=46%).
Conclusions
Evidence of effect on CVD risk factors from interventions to alter consultations between practitioners and patients with type 2 diabetes was heterogeneous and inconclusive. This could be explained by variable impact of interventions on consultations. More research is required that includes robust measures of the consultations and better development of theory to elucidate mechanisms.</description><identifier>ISSN: 1369-6513</identifier><identifier>EISSN: 1369-7625</identifier><identifier>DOI: 10.1111/hex.12546</identifier><identifier>PMID: 28245085</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Bias ; Blood cholesterol ; Blood pressure ; cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - blood ; Cholesterol ; Clinical trials ; Consultation ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - therapy ; doctor‐patient relationship ; Evidence-based medicine ; Extraction ; Glycated Hemoglobin A ; Health care ; Health risk assessment ; Health risks ; Hemoglobin ; High density lipoprotein ; Intervention ; Low density lipoprotein ; Low density lipoproteins ; Mathematical analysis ; Meta-analysis ; Patients ; patient‐practitioner interactions ; Primary care ; Primary Health Care ; Randomized Controlled Trials as Topic ; Referral and Consultation ; Review ; Risk analysis ; Risk Factors ; Software ; Statistical analysis ; Subgroups ; Systematic review ; Trans fatty acids ; Type 2 diabetes ; Type 2 diabetes mellitus ; Variables</subject><ispartof>Health expectations : an international journal of public participation in health care and health policy, 2017-12, Vol.20 (6), p.1218-1227</ispartof><rights>2017 The Authors Health Expectations Published by John Wiley & Sons Ltd</rights><rights>2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.</rights><rights>COPYRIGHT 2017 John Wiley & Sons, Inc.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><rights>2017. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5386-325320ed1b0a6bcf7cf8fffab86cbb73ca0f9d9a214a12754ab0833c96a2e9ef3</citedby><cites>FETCH-LOGICAL-c5386-325320ed1b0a6bcf7cf8fffab86cbb73ca0f9d9a214a12754ab0833c96a2e9ef3</cites><orcidid>0000-0003-0175-443X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689230/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689230/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,1416,11561,12845,27923,27924,30998,45573,45574,46051,46475,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28245085$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dambha‐Miller, Hajira</creatorcontrib><creatorcontrib>Cooper, Andrew J. M.</creatorcontrib><creatorcontrib>Kinmonth, Ann Louise</creatorcontrib><creatorcontrib>Griffin, Simon J.</creatorcontrib><title>Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta‐analysis of trials in primary care</title><title>Health expectations : an international journal of public participation in health care and health policy</title><addtitle>Health Expect</addtitle><description>Objective
To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.
Search Strategy
Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs).
Inclusion Criteria
RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care.
Data extraction and synthesis
We recorded if explicit theory‐based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL‐C) and HDL cholesterol (HDL‐C).
Results
We included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA1c levels (weighted mean difference, −0.53%; 95% CI: [−0.77, −0.28]; P<.0001; I2=46%).
Conclusions
Evidence of effect on CVD risk factors from interventions to alter consultations between practitioners and patients with type 2 diabetes was heterogeneous and inconclusive. This could be explained by variable impact of interventions on consultations. More research is required that includes robust measures of the consultations and better development of theory to elucidate mechanisms.</description><subject>Bias</subject><subject>Blood cholesterol</subject><subject>Blood pressure</subject><subject>cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - blood</subject><subject>Cholesterol</subject><subject>Clinical trials</subject><subject>Consultation</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>doctor‐patient relationship</subject><subject>Evidence-based medicine</subject><subject>Extraction</subject><subject>Glycated Hemoglobin A</subject><subject>Health care</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Hemoglobin</subject><subject>High density lipoprotein</subject><subject>Intervention</subject><subject>Low density lipoprotein</subject><subject>Low density lipoproteins</subject><subject>Mathematical analysis</subject><subject>Meta-analysis</subject><subject>Patients</subject><subject>patient‐practitioner interactions</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Referral and Consultation</subject><subject>Review</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Subgroups</subject><subject>Systematic review</subject><subject>Trans fatty acids</subject><subject>Type 2 diabetes</subject><subject>Type 2 diabetes mellitus</subject><subject>Variables</subject><issn>1369-6513</issn><issn>1369-7625</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9ks9u1DAQxiMEoqVw4AWQJS5w2K3tbJyEA9KqKhSpEheQuFkTZ9x1SeLFdnbZG4_Ao_EMPAmzf6haBMSHJOPf9814PFn2VPCpoOd0gV-nQhYzdS87FrmqJ6WSxf3DtypEfpQ9ivGac1HmVfkwO5KVnBW8Ko6zH-fWoknMD8xAaJ1fQTRjB4G1LiJEZMHFz8yCST5E5i1zQ8KwwiE5P0SWPIOOAszQ39gl2IcbTGvEgS0DCd02hqSGoWVLIkgc2dqlBUubJTJJuYAUGF-xOYubmLAnyrCAK4frnazHBD-_fYcBuk10u0JScNBFqoeyuB7CZnsCfJw9sBTGJ4f3SfbxzfmHs4vJ5fu3787mlxNT5JWa5LLIJcdWNBxUY2xpbGWthaZSpmnK3AC3dVuDFDMQsixm0PAqz02tQGKNNj_JXu99l2PTY2voTAE6fShFe3D67s7gFvrKr3ShqlrmnAxeHAyC_zJiTLp30WDXwYB-jFpUpawqusmS0Od_oNd-DNSKqKWsuVRUn_ofJWo1U0IU9S2vK-hQu8F6qs5sU-t5KTjly2VF1PQvFK0We0dXjdZR_I7g5V5ggo8xoL3phOB6O6SahlTvhpTYZ7dbd0P-nkoCTvfAmrJs_u2kL84_7S1_AUSn9vo</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Dambha‐Miller, Hajira</creator><creator>Cooper, Andrew J. M.</creator><creator>Kinmonth, Ann Louise</creator><creator>Griffin, Simon J.</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>3V.</scope><scope>7RV</scope><scope>7T2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0175-443X</orcidid></search><sort><creationdate>201712</creationdate><title>Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta‐analysis of trials in primary care</title><author>Dambha‐Miller, Hajira ; Cooper, Andrew J. M. ; Kinmonth, Ann Louise ; Griffin, Simon J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5386-325320ed1b0a6bcf7cf8fffab86cbb73ca0f9d9a214a12754ab0833c96a2e9ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Bias</topic><topic>Blood cholesterol</topic><topic>Blood pressure</topic><topic>cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - blood</topic><topic>Cholesterol</topic><topic>Clinical trials</topic><topic>Consultation</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>doctor‐patient relationship</topic><topic>Evidence-based medicine</topic><topic>Extraction</topic><topic>Glycated Hemoglobin A</topic><topic>Health care</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Hemoglobin</topic><topic>High density lipoprotein</topic><topic>Intervention</topic><topic>Low density lipoprotein</topic><topic>Low density lipoproteins</topic><topic>Mathematical analysis</topic><topic>Meta-analysis</topic><topic>Patients</topic><topic>patient‐practitioner interactions</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Referral and Consultation</topic><topic>Review</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Software</topic><topic>Statistical analysis</topic><topic>Subgroups</topic><topic>Systematic review</topic><topic>Trans fatty acids</topic><topic>Type 2 diabetes</topic><topic>Type 2 diabetes mellitus</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dambha‐Miller, Hajira</creatorcontrib><creatorcontrib>Cooper, Andrew J. 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M.</au><au>Kinmonth, Ann Louise</au><au>Griffin, Simon J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta‐analysis of trials in primary care</atitle><jtitle>Health expectations : an international journal of public participation in health care and health policy</jtitle><addtitle>Health Expect</addtitle><date>2017-12</date><risdate>2017</risdate><volume>20</volume><issue>6</issue><spage>1218</spage><epage>1227</epage><pages>1218-1227</pages><issn>1369-6513</issn><eissn>1369-7625</eissn><abstract>Objective
To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes.
Search Strategy
Electronic and manual citation searching to identify relevant randomized controlled trials (RCTs).
Inclusion Criteria
RCTs that compared usual care to interventions to alter consultations between practitioners and patients. The population was adults aged over 18 years with type 2 diabetes. Trials were set in primary care.
Data extraction and synthesis
We recorded if explicit theory‐based interventions were used, how consultations were measured to determine whether interventions had an effect on these and calculated weighted mean differences for CVD risk factors including glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), LDL cholesterol (LDL‐C) and HDL cholesterol (HDL‐C).
Results
We included seven RCTs with a total of 2277 patients with type 2 diabetes. A range of measures of the consultation was reported, and underlying theory to explain intervention processes was generally undeveloped and poorly applied. There were no overall effects on CVD risk factors; however, trials were heterogeneous. Subgroup analysis suggested some benefit among studies in which interventions demonstrated impact on consultations; statistically significant reductions in HbA1c levels (weighted mean difference, −0.53%; 95% CI: [−0.77, −0.28]; P<.0001; I2=46%).
Conclusions
Evidence of effect on CVD risk factors from interventions to alter consultations between practitioners and patients with type 2 diabetes was heterogeneous and inconclusive. This could be explained by variable impact of interventions on consultations. More research is required that includes robust measures of the consultations and better development of theory to elucidate mechanisms.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>28245085</pmid><doi>10.1111/hex.12546</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-0175-443X</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1369-6513 |
| ispartof | Health expectations : an international journal of public participation in health care and health policy, 2017-12, Vol.20 (6), p.1218-1227 |
| issn | 1369-6513 1369-7625 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5689230 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Applied Social Sciences Index & Abstracts (ASSIA); Wiley-Blackwell Open Access Titles; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals; PubMed Central |
| subjects | Bias Blood cholesterol Blood pressure cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - blood Cholesterol Clinical trials Consultation Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - therapy doctor‐patient relationship Evidence-based medicine Extraction Glycated Hemoglobin A Health care Health risk assessment Health risks Hemoglobin High density lipoprotein Intervention Low density lipoprotein Low density lipoproteins Mathematical analysis Meta-analysis Patients patient‐practitioner interactions Primary care Primary Health Care Randomized Controlled Trials as Topic Referral and Consultation Review Risk analysis Risk Factors Software Statistical analysis Subgroups Systematic review Trans fatty acids Type 2 diabetes Type 2 diabetes mellitus Variables |
| title | Effect on cardiovascular disease risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes: A systematic review and meta‐analysis of trials in primary care |
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