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The Microalbuminuria Education Medication and Optimisation ( MEMO ) study: 4 years follow‐up of multifactorial intervention in high‐risk individuals with type 2 diabetes
Author(s) -
Crasto W.,
Morrison A. E.,
Gray L. J.,
John E.,
Jarvis J.,
Brela J.,
Khunti K.,
Troughton J.,
Lawrence I. G.,
McNally P. G.,
Davies M. J.
Publication year - 2020
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14134
Subject(s) - medicine , microalbuminuria , type 2 diabetes , blood pressure , population , diabetes mellitus , confidence interval , endocrinology , environmental health
Aims The Microalbuminuria Education Medication and Optimisation ( MEMO ) study, revealed improved cardiovascular risk and glycaemic control with 18 months of intensive multifactorial intervention in high‐risk people with type 2 diabetes, without any increase in severe hypoglycaemia. Our aim was to assess longer‐term outcomes at 4‐year follow‐up in these participants. Methods Some 189 individuals with type 2 diabetes and microalbuminuria were recruited from a multi‐ethnic population in Leicestershire, UK . The intervention group ( n = 95) received multifactorial intervention with self‐management education, and the control group ( n = 94) received usual care. The primary outcome was change in HbA 1c , and secondary outcomes were blood pressure ( BP ), cholesterol, microalbuminuria, estimated GFR , cardiovascular risk scores and major adverse cardiovascular events. Results Some 130 participants (68.7%), mean ( sd ) age 60.8 (10.4) years, duration of diabetes 11.5 (9.7) years, completed 4 years of follow‐up. Mean change [95% confidence intervals ( CI )] in HbA 1c over 4 years was greater with intensive intervention compared with control (−3 mmol/mol, 95% CI −4.95,−1.11; −0.4%, 95% CI −0.67,−0.15; P = 0.002). Significant improvements over the 4 years were also seen in systolic BP (−7.3 mmHg, 95% CI −11.1, −3.5; P < 0.001), diastolic BP (−2.9 mmHg, 95% CI −5.4, −0.3; P = 0.026), cholesterol (−0.3 mmol/l, 95% CI −0.52,−0.12; P = 0.002), and 10‐year coronary heart disease (−5.3, 95% CI −8.2,−2.3; P < 0.001) and stroke risk (−4.4, 95% CI −7.5, −1.3; P < 0.001). Conclusion Multifactorial intervention with structured diabetes self‐management education compared with usual diabetes care has benefits for cardio‐metabolic risk factor profile. There was no increase in severe hypoglycaemia and cardiovascular mortality despite intensive glycaemic control, although the study was not powered to assess these outcomes.