Improvement of primary health care for patients with diabetes

ISRCTN ISRCTN70713571
DOI https://doi.org/10.1186/ISRCTN70713571
Secondary identifying numbers 01GX1041
Submission date
10/03/2011
Registration date
17/06/2011
Last edited
15/05/2023
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Nutritional, Metabolic, Endocrine
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
The aim of this study is to improve primary healthcare for patients with poorly regulated type 2 diabetes mellitus by improving communication between the patient and the general practitioner (GP). We want to enable participating GPs to identify the needs of patients suffering from poorly regulated type 2 diabetes mellitus, and to foster shared decision-making.

Who can participate?
We will recruit about 60 GPs in three study centres (Rostock, Düsseldorf and Witten-Herdecke), who will each include about 13 randomly chosen type 2 diabetes mellitus patients (780 in total).

What does the study involve?
Participating GPs will be randomly allocated into either the intervention or the control group. Patient data, such as HbA1c level and prescribed drugs, will be collected at five different points in time during the study period of 36 months. Patients whose GPs are assigned into the control group will be treated as usual. The GPs assigned to the intervention group will have a conversation with a GP peer, which aims at increasing their motivation to improve poorly regulated blood sugar levels of patients suffering from type 2 diabetes. They will also be trained and equipped with a computer-based communication tool called arriba, which is especially adapted to patients suffering from diabetes. The effect of the intervention will be measured by the changes in the patient's blood sugar level, by their level of participation in the process of shared decision-making, and their quality of life.

What are the possible benefits and risks of participating?
Patients may benefit from improved management of their type 2 diabetes. There are no risks of participating.

Where is the study run from?
We will recruit about 60 GPs in three study centres (Rostock, Düsseldorf and Witten-Herdecke). The study is run from the University of Rostock (Germany).

When is the study starting and how long is it expected to run for?
The study started in March 2011 and will run until August 2015.

Who is funding the study?
German Federal Ministry of Education and Research (BMBF) (Germany).

Who is the main contact?
Prof Attila Altiner
ifa.sekretariat@med.uni-rostock.de

Contact information

Prof Attila Altiner
Scientific

University of Rostock
Medizinische Fakultät
Institut für Allgemeinmedizin
POB 100888
Rostock
18055
Germany

Phone +49 (0)38 1494 2481
Email ifa.sekretariat@med.uni-rostock.de

Study information

Study designCluster-randomised controlled trial with educative intervention
Primary study designInterventional
Secondary study designCluster randomised trial
Study setting(s)GP practice
Study typeTreatment
Participant information sheet http://allgemeinmedizin.med.uni-rostock.de/uploads/media/Informationsblatt-Pat_DEBATE_20110415.pdf (In German)
Scientific titleImprovement of primary health care of patients with poorly regulated diabetes mellitus type 2 using shared decision-making
Study acronymDEBATE
Study objectivesChanging the communication behaviour of general practitioners to foster shared decision-making (with their patients) utilising developed top decision-aid-diabetes (decision-aid arriba-diabetes) improves health outcomes of patients with poorly regulated diabetes cared for in primary health. HbA1c serves as primary outcome measure.

On 19/05/2014 the overall trial end date was changed from 28/02/2014 to 31/08/2015.

On 30/06/2015 the target number of participants was changed from '60 GPs each with 13 patients; a total of 780 patients' to '108 GPs, each recruiting a consecutive sample of up to 13 patients (on average 7.8 patients per practice), a total of 843 patients'.
Ethics approval(s)Ethics Committee of the Medical Faculty, University of Rostock, 25/05/2011
Health condition(s) or problem(s) studiedDiabetes mellitus type 2
Intervention1. Cluster-randomised multi-centre controlled trial with an educative intervention (peer-visit and decision-aid arriba-diabetes)
2. Clusters are composed by GPs and patients
3. The GPs in the intervention group will receive an educational peer-visit
4. The peer himself will be a specially trained GP
5. The control group will receive care as usual
6. The study will be performed under real practice conditions
Intervention typeBehavioural
Primary outcome measureCurrent primary outcome as of 10/01/2012
1. Change of HbA1c at 6, 12, 18, 24 months compared to HbA1c at baseline
2. HbA1c will be measured as routine examinaton, as the case may be within the scope of the German Disease Management Program performed at GP's medical practice

Previous primary outcome
1. Change of HbA1c at 6, 12, 18, 24 months compared to HbA1c at baseline
2. HbA1c will be measured as routine examination within the scope of the German Disease Management Program performed at GP's medical practice
Secondary outcome measuresCurrent secondary outcome as of 10/01/2012
1. Patient's evaluation of patient-centeredness and life quality (PACIC-D, PEF-FB-9, BÄK-questionnaire, EQ-5D, PAID)
2. Cardiovascular risk prognosis
3. Pharmacotherapy

Previous secondary outcome
1. Patient's evaluation of patient-centeredness and life quality (PACIC-D, PEF-FB-9, SF-36)
2. Cardiovascular risk prognosis
3. Pharmacotherapy
Overall study start date01/03/2011
Completion date31/08/2015

Eligibility

Participant type(s)Mixed
Age groupAdult
SexBoth
Target number of participants108 GPs, each recruiting a consecutive sample of up to 13 patients (on average 7.8 patients per practice), a total of 843 patients
Total final enrolment833
Key inclusion criteriaCurrent inclusion criteria as of 30/06/2015:
Patients:
1. Diabetes mellitus type 2
2. HbA1c level of 8.0 or above at the time of recruitment
3. Ability to informed consent
4. Fluency in the German language

GPs:
1. General practitioner or internist, working as GP or practitioner with KV admission (Association of Statutory Health Insurance Physicians)

Previous inclusion criteria from 10/01/2012 to 30/06/2015:
Patients:
1. Diabetes mellitus type 2
2. HbA1c level of 8.1 or above at the time of recruitment
3. Ability to informed consent
4. Fluency in the German language

GPs:
1. General practitioner or internist, working as GP or practitioner with KV admission (Association of Statutory Health Insurance Physicians)

Original inclusion criteria until 10/01/2012:
Patients:
1. Diabetes mellitus type 2
2. HbA1c level of 8.5 or above at the time of recruitment
3. Ability to informed consent
4. Fluency in the German language

GPs:
1. General practitioner or internist, working as GP or practitioner with KV admission (Association of Statutory Health Insurance Physicians)
2. Participation on the Disease Management Program diabetes mellitus type 2
Key exclusion criteria1. Severe comorbidity
2. Life expectancy of less than 18 months
Date of first enrolment01/03/2011
Date of final enrolment31/08/2015

Locations

Countries of recruitment

  • Germany

Study participating centres

The Institute of General Practice
University Medical Center Rostock
Doberaner Strasse 142
P.O. Box 108880
Rostock
18057
Germany
The Institute of General Practice
Universitätsklinikum der Heinrich-Heine Universität Düsseldorf
Moorenstraße 5
Düsseldorf
40225
Germany
The Institute of General Practice and Family Practice
Fakultät für Gesundheit
Universität Witten/Herdecke
Alfred-Herrhausen-Straße 50
Witten
58448
Germany

Sponsor information

German Federal Ministry of Education and Research (BMBF) (Germany)
Government

c/o Projektträger im DLR
Heinrich-Konen-Straße 1
Bonn
53227
Germany

Phone +49 (0)22 8382 1152
Email Eva.Becher@dlr.de
Website http://dlr.de
ROR logo "ROR" https://ror.org/04pz7b180

Funders

Funder type

Government

Bundesministerium für Bildung und Forschung
Government organisation / National government
Alternative name(s)
Federal Ministry of Education and Research, BMBF
Location
Germany

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 25/06/2019 27/06/2019 Yes No
Results article 15/05/2021 17/05/2021 Yes No
Results article Secondary analysis 13/05/2023 15/05/2023 Yes No

Editorial Notes

15/05/2023: Publication reference added.
17/05/2021: Publication reference added.
27/06/2019: Publication reference and total final enrolment added.