The GIANT study, a cluster-randomised controlled trial of efficacy of education of doctors about type 2 diabetes mellitus management guidelines in primary care practice.
OBJECTIVE
Primary aim: does general practitioner (GP) education on type 2 diabetes treatment improve HbA1c? Secondary aim: cardiovascular risk factors, hypoglycaemia, treatment intensification, health service utilisation, treatment barriers.


METHODS
99 Asia-Pacific GPs were cluster-randomised to be educated on regional diabetes management guidelines (intervention) or continue standard care (control). The intervention employed meetings, reminders, medical record summary sheets and patient result cards. Each GP recruited four type 2 diabetic patients, assessed at baseline, 6 and 12 months. The primary outcome was mean change in HbA1c from 0 to 6 months in patients with baseline HbA1c≥6.5%.


RESULTS
361 patients (93%) completed 6 month follow-up. The primary HbA1c outcome was -0.11% (95% CI -0.27, 0.05) with intervention and -0.22% (95% CI -0.39, -0.05) in the control group (p=0.340). The groups did not differ in control of other glycaemic indices, blood pressure or lipids after 6 or 12 months. In those with HbA1c≥9.0%, approximately 50% received intensified treatment by 6 months, and 30% in the final 6 months. GPs identified treatment costs and patient reluctance to use insulin as management barriers.


CONCLUSIONS
A structured GP education programme did not improve HbA1c in patients with type 2 diabetes.
Baker IDI Heart and Diabetes Institute, Melbourne, Australia. anne.reutens@bakeridi.edu.au
Anne T
AT
Reutens
Richard
R
Hutchinson
Ta
T
Van Binh
Clive
C
Cockram
Chaicharn
C
Deerochanawong
Low-Tone
LT
Ho
Linong
L
Ji
Bin Abdul Kadir
BA
Khalid
Alice Pik Shan
AP
Kong
Mary Ann
MA
Lim-Abrahan
Chee-Eng
CE
Tan
Askandar
A
Tjokroprawiro
Kun-Ho
KH
Yoon
Paul Z
PZ
Zimmet
Jonathan E
JE
Shaw
D000328:Adult; D001208:Asia / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners / Q000193:education* / Q000706:statistics & numerical data; D006442:Glycated Hemoglobin / Q000378:metabolism*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010139:Pacific Islands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human