title: Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS).
abstract: OBJECTIVE
  We tested the hypothesis that enhanced care for diabetes, tailored to the needs of the South Asian community with Type 2 diabetes, would improve risk factors for diabetic vascular complications and ultimately reduce morbidity and mortality.
  
  
  METHODS
  The study was a cluster randomized controlled trial (RCT) with general practice the unit of randomization. Six West Midlands general practices with a high proportion of South Asian patients were randomized to 'enhanced care' using Asian link workers and extra community diabetes specialist nurse sessions (intervention) or continued standard practice care (control).
  
  
  RESULTS
  Of 401 patients recruited to the study, 361 (90%), comprising 178 from Coventry and 183 from Birmingham were eligible and included in the analyses. The mean age at baseline (standard deviation, SD) was 58.9 (11.7 years) with median (interquartile range; IQR) duration of diabetes 6.5 (3-11) years. At one year follow-up there was a significant difference in reduction of systolic (4.6 mmHg, P = 0.035) and diastolic blood pressure (3.4 mmHg, P = 0.003) and total cholesterol (0.4 mmol/l, P = 0.005), comparing the intervention and control groups. After adjusting for baseline measurement and age, only differential reduction in diastolic blood pressure remained significant. There was no significant change in HbA(1c) and no difference between the groups.
  
  
  CONCLUSIONS
  Using link workers and extra community diabetes specialist nurse input together with treatment protocols in primary care might prove a useful strategy in working towards NSF targets for diabetes management. In this study, small reductions in blood pressure and cholesterol were achieved. Improvement in glycaemic control may require longer and possibly different strategies. Further research is required to evaluate fully the effectiveness, including the costs and longer term sustainability of culturally sensitive initiatives.
authors.affiliation: Biomedical Research Institute, University of Warwick, Coventry, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: O'Hare
authors.forename: N T
authors.initials: NT
authors.lastname: Raymond
authors.forename: S
authors.initials: S
authors.lastname: Mughal
authors.forename: L
authors.initials: L
authors.lastname: Dodd
authors.forename: W
authors.initials: W
authors.lastname: Hanif
authors.forename: Y
authors.initials: Y
authors.lastname: Ahmad
authors.forename: K
authors.initials: K
authors.lastname: Mishra
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: A
authors.initials: A
authors.lastname: Szczepura
authors.forename: E W
authors.initials: EW
authors.lastname: Hillhouse
authors.forename: A H
authors.initials: AH
authors.lastname: Barnett
mesh_terms: D000368:Aged; D001210:Asia, Southeastern / Q000208:ethnology; D001794:Blood Pressure; D003152:Community Health Nursing; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology* / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000517:prevention & control; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom
chemical_list: D006442:Glycated Hemoglobin