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Impact of multifactorial interventions with medication and lifestyle optimization on patients with type 2 diabetes: A
Marwan El-Deyarbi1,2, Luai Ahmed3, Jeffrey King4,5
1Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
Background:
Clinical evidence on the protective effects of a balanced diet, exercise, and medication adherence along with intensive glucose-lowering therapies on diabetes progression is lacking, and interventions that are most effective in slowing cardiorenal metabolic complications in patients with diabetes remain unelucidated.
Objective:
To determine the effects of long-term multifactorial interventions on clinical outcomes in Emirati patients with diabetes attending ambulatory healthcare clinics.
Methods:
We conducted a randomised controlled clinical trial at the Oud Al-Touba Clinic involving 192 participants with diabetes, who were blinded to the intervention and control groups, and followed up for 1 year. At the 3-, 6-, and 9-month visits, the intervention and control groups received multifactorial interventions and standard routine care, respectively. Glycated haemoglobin A1c (HbA1c) levels, estimated glomerular filtration rate (eGFR), blood pressure, electrolyte levels, and cardiovascular events were assessed at study completion.
Results:
During a mean follow-up of 11.9 months, 40.4% of the participants in the intervention group (31.6% in the control group) achieved diabetes control (HbA1c < 7%), with a significant mean difference of -0.36% in HbA1c levels between the groups (95% CI: -0.54 - -0.19, P < 0.01). Participants in the multifactorial group achieved a significant mean difference in low-density lipoprotein cholesterol levels (mean difference = -0.14, 95% CI: -0.27-0.001, P < 0.03), and significant adjusted mean difference of eGFR levels difference (3.93 mL/min/1.73 m2, 95% CI: 1.27-6.58, P < 0.01) at study completion compared to those in the control group. Moreover, the percentage of participants in the intervention group who met the blood pressure target increased from 38.3% to 51.1%, accompanied with a decrease in serum electrolyte levels, compared to 34.7% to 36.7% in the control group at the end of the follow-up.
Conclusions:
Implementing multifactorial interventions by a multidisciplinary team improved several clinical manifestations, including HbA1c, SBP, and eGFR, and decreased cardiovascular risk factors despite the decreased diabetes medication use.
Trial Registration:
ClinicalTrials.gov NCT04942119.
Insights
Multifactorial interventions improved diabetes control (HbA1c) and kidney function (eGFR) in Emirati patients. This approach reduced cardiovascular risk factors, showing benefits beyond medication alone.
Area of Science:
- Endocrinology
- Nephrology
- Cardiology
Background:
- Limited evidence exists on comprehensive interventions for diabetes progression and cardiorenal complications.
- Identifying effective strategies for managing diabetes in ambulatory settings is crucial.
Purpose of the Study:
- To evaluate the long-term impact of multifactorial interventions on clinical outcomes in Emirati patients with diabetes.
- To assess the effectiveness of a multidisciplinary approach in managing diabetes and its complications.
Main Methods:
- A 1-year randomized controlled trial involving 192 diabetic participants in ambulatory care.
- Intervention group received multifactorial care; control group received standard care.
- Key outcomes included HbA1c, eGFR, blood pressure, lipids, and cardiovascular events.
Main Results:
- The intervention group showed a significant reduction in HbA1c (-0.36%) and improved low-density lipoprotein cholesterol levels (-0.14).
- Significant improvements in estimated glomerular filtration rate (eGFR) were observed in the intervention group (3.93 mL/min/1.73 m2).
- A higher percentage of intervention participants achieved blood pressure targets (51.1% vs 36.7%).
Conclusions:
- Multifactorial interventions by a multidisciplinary team significantly improved glycemic control (HbA1c), blood pressure (SBP), and kidney function (eGFR).
- These interventions effectively decreased cardiovascular risk factors in diabetic patients.
- The study highlights the benefits of a comprehensive approach, even with reduced diabetes medication use.
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