title: A systematic review of interventions targeting primary care or community based professionals on cardio-metabolic risk factor control in people with diabetes.
abstract: OBJECTIVE
  To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes.
  
  
  METHODS
  A systematic review of randomised controlled trials evaluating the effectiveness of interventions targeting primary care or community based professionals on diabetes and cardiovascular risk factor control. We conducted searches in MEDLINE database from inception up to 27th September 2015. We also retrieved articles related to diabetes from the Cochrane EPOC database and EMBASE and scanned bibliographies for key articles.
  
  
  RESULTS
  There was heterogeneity in terms of interventions and participants amongst the 30 studies (39,439 patients) that met the inclusion criteria. Nine of the studies focused on general or family practitioners, five on pharmacists, three on nurses and one each on dieticians and community workers. Twelve studies targeted multi-disciplinary teams. Educational interventions did not seem to have a positive impact on HbA1c, systolic blood pressure or lipid profiles. The use of telemedicine, clinician reminders and feedback showed mixed results but there was a level of consistency in improvement in HbA1c when multifaceted interventions on multidisciplinary teams were implemented. Targeting general or family physicians was largely ineffective in improving the cardiovascular risk factors considered, except when using a computer application on insulin handling of type 2 diabetes or customised simulated cases with feedbacks. Similarly, interventions targeting nurses did not improve outcomes compared to standard care.
  
  
  CONCLUSIONS
  Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control.
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK. Electronic address: sis11@le.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Seidu
authors.affiliation: Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Walker
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Bodicoat
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003151:Community Health Centers / Q000592:standards*; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D024821:Metabolic Syndrome / Q000209:etiology / Q000517:prevention & control*; D011320:Primary Health Care / Q000592:standards*; D012307:Risk Factors
keywords: Diabetes; Health care professional; Interventions; Primary care