title: Multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: the Microalbuminuria Education and Medication Optimisation (MEMO) study.
abstract: OBJECTIVE
  To determine whether tighter cardiovascular risk factor control with structured education in individuals with type 2 diabetes (T2DM) and microalbuminuria benefits cardiovascular risk factors.
  
  
  METHODS
  Participants from a multiethnic population, recruited from primary care and specialist clinics were randomised to intensive intervention with structured patient (DESMOND model) education (n=94) or usual care by own health professional (n=95).
  
  
  METHODS
  change in HbA1c at 18months.
  
  
  RESULTS
  changes in blood pressure (BP), cholesterol, albuminuria, proportion reaching risk factor targets, modelled cardiovascular risk scores.
  
  
  RESULTS
  Mean (SD) age and diabetes duration of participants were 61.5 (10.5) and 11.5 (9.3) years, respectively. At 18months, intensive intervention showed significant improvements in HbA1c (7.1(1.0) vs. 7.8(1.4)%, p<0.0001), systolic BP (129(16) vs. 139(17) mmHg, p<0.0001), diastolic BP (70(11) vs. 76(12) mmHg, p<0.001), total cholesterol (3.7(0.8) vs. 4.1(0.9) mmol/l, p=0.001). Moderate and severe hypoglycaemia was 11.2 vs. 29.0%; p=0.001 and 0 vs. 6.3%; p=0.07, respectively. More intensive participants achieved ≥3 risk factor targets with greater reductions in cardiovascular risk scores.
  
  
  CONCLUSIONS
  Intensive intervention showed greater improvements in metabolic control and cardiovascular risk profile with lower rates of moderate and severe hypoglycaemia. Intensive glycaemic interventions should be underpinned by structured education promoting self-management in T2DM.
authors.affiliation: University Hospitals of Leicester, UK. winston.crasto@uhl-tr.nhs.uk
authors.forename: W
authors.initials: W
authors.lastname: Crasto
authors.forename: J
authors.initials: J
authors.lastname: Jarvis
authors.forename: K
authors.initials: K
authors.lastname: Khunti
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
authors.forename: L J
authors.initials: LJ
authors.lastname: Gray
authors.forename: J
authors.initials: J
authors.lastname: Brela
authors.forename: J
authors.initials: J
authors.lastname: Troughton
authors.forename: H
authors.initials: H
authors.lastname: Daly
authors.forename: I G
authors.initials: IG
authors.lastname: Lawrence
authors.forename: P G
authors.initials: PG
authors.lastname: McNally
authors.forename: M E
authors.initials: ME
authors.lastname: Carey
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000097:blood / Q000188:drug therapy* / Q000652:urine*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000652:urine*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy / Q000652:urine; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D001241:Aspirin; D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D008687:Metformin