Quality improvement strategies improve achievement of diabetes care goals, study finds

Researchers at the Rollins School of Public Health, along with the Public Health Foundation of India and the All India Institute of Medical Sciences, found that a low-cost care, intervention model can help patients with diabetes double their likelihood of controlling the disease.

In a study published in the July 12 edition of Annals of Internal Medicine, researchers analyzed results from a new trial conducted at 10 clinical centers throughout India and Pakistan to compare the effect of a multicomponent, diabetes-focused quality improvement (QI) strategy versus the usual care alternatives for heart patients with poorly controlled diabetes. 

Led by Mohammed K. Ali, MBChB, MSc, associate professor at Emory’s Rollins School of Public Health, the team compared the effects of multicomponent diabetes QI strategy versus usual care in South Asia, where resources are limited and diabetes is prevalent.

Approximately 1,150 patients with diabetes and poor cardiometabolic profiles were randomly assigned to a multicomponent QI strategy or usual care for two and a-half years. Results suggested that patients in the QI strategy group were twice as likely to achieve combined diabetes care goals and larger reductions for each risk factor compared with usual care.

“This was the first trial of comprehensive diabetes management in a low/middle-income country setting,” explains Ali. “This intervention doesn’t require new or expensive drugs, but instead it enhances a patient’s likelihood of managing their disease on their own by providing individualized support and enhancing the physician’s likelihood of being responsive.”

Findings from the trial also showed that the new intervention yielded sizeable improvements in the blood sugar, blood pressure and cholesterol profiles of participants. Benefits were similar in public and private diabetes clinics indicating that, with structured care, health inequalities can possibly be reduced. 

“By better controlling blood sugar, blood pressure, and cholesterol levels, our study offers a hope of reducing onset of diabetes complications like heart disease, eye disease, kidney failure and amputations, which are very common in people with diabetes in South Asia,” says Ali.

“Since these findings are relevant for the US, India, Pakistan, and many other countries, including low-, middle-, and high-income countries, further research will uncover whether this approach reduces diabetes complications such as heart attacks, strokes, eye disease, kidney failure and amputations in the long-term and will assess patients’ and providers’ views so that the intervention can be delivered more widely.”