An Evaluation of the Effectiveness and Acceptability of Delivering Structured Care in Chinese Type 2 Diabetic Patients (JADE-JA)

• Percentage of patients who attain 2 or more of the 'ABC'targets [ Time Frame: 12 months ] [ Designated as safety issue: No ]

  Percentage of patients who attain 2 or more of the following 3 targets:

  1. HbA1c <7%
  2. BP <130/80 mmHg
  3. LDL cholesterol <2.6 mmol/L
  
  

• New onset of all diabetes-related endpoints [ Time Frame: 12 months ] [ Designated as safety issue: No ]

  This includes:

  1. cardiovascular endpoints (acute myocardial infarction, revascularisation procedures, heart failure or unstable angina or arrhythmia requiring hospital admissions, stroke, lower extremity amputation or foot ulcers);
  2. chronic kidney disease (eGFR<60 ml/min/1.73m2) and end stage renal disease (dialysis and/or eGFR<30;ml/min/1.73m2)
  3. visual impairment (corrected visual acuity of 20/200 or lower) or eye surgery;
  4. cancer
  5. any hospitalization due to complications related to diabetes and/or its treatment (such as hypoglycaemic attacks)
  6. death
  
  
• Quality of Life [ Time Frame: 12 Months ] [ Designated as safety issue: No ]
  
• Behavioral changes (in the last 3 months) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  1. Frequency of Self Blood Glucose Monitoring (SBGM)
  2. Adherence to balanced eating
  3. Adherence to regular exercise
  4. Adherence to recommended procedures (e.g. return for blood tests or education classes)
  
  
• Frequency of hypoglycaemia (in the last 3 months) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Number of hospitalizations, follow up visits by doctors and other care professionals during the 12 months [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  
• Default rates at the end of the study [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  

In 2007, supported by an educational grant, a charitable organization named the Asia Diabetes Foundation (ADF) (www.adf.org.hk) was established to develop the Joint Asia Diabetes Evaluation (JADE) Program, which comprises a web-based disease management program to enable doctors, nurses and other care personnel to manage people with diabetes in an integrated and effective manner. The JADE electronic portal (e portal) provides a virtual platform to facilitate implementation of evidence-based clinical protocols with ongoing data collection, management and analysis to track performance for quality assurance and improvement purposes. The JADE Program also incorporates validated risk equations developed by the Chinese University of Hong Kong (CUHK) Diabetes Care & Research Group to stratify patients into various risk levels for recommendation of triage into different care protocols with decision supports. This clinical information, presented in the forms of charts and time trends, can be communicated to patients and care providers to motivate behavioral changes, set treatment goals and attain targets.

By participating in the JADE Program, the doctors will be able to create their own diabetes registry to benchmark their performance including adherence to procedures, recall of default patients and rate of attainment of treatment targets. In this regard, the implementation of the full JADE Program requires changes in the practice environment and deployment of additional manpower (e.g. a nurse and a HCA) to enter data and provide reminders to patients and doctors to improve adherence to protocols.

It is anticipated that the cost-effectiveness of the structured (JADE group) versus usual (non-JADE group) care on rates of attainment of multiple treatment targets, which will translate into clinical outcomes in the long term, will eventually change practice and policy to make quality diabetes care more affordable, sustainable and accessible in China.

In this 1-year multi-centre randomized study, the investigators shall use a web-based disease management program (JADE e portal) to facilitate implementation of structured care with the following objectives:

• To evaluate the reach, adoption and acceptability of the JADE e portal by patients and health care team
• To compare the effectiveness of the JADE versus non-JADE Program in attainment of treatment targets, improvement of quality of life and changes in behaviours
• To document the pattern of complications, risk factors, use of medications and quality of life in type 2 diabetic patients in Jiangsu and Anhui, China.