Summary of findings 5. Clinician reminders compared to no clinician reminders for diabetes quality improvement.
| Outcome | Anticipated absolute effects (95% CrI) | № of participants (studies) | Certainty | ||||
| Post‐treatment mean with no clinician reminders | Difference with clinician reminders | ||||||
| HbA1c (< or = to 8.3%) | The mean HbA1c was 7.48% (7.42 to 7.55) | MD 0.09% higher (0.02 lower to 0.20 higher) | 129,327 (234 RCTs) | ⨁⨁◯◯ Lowa,b | |||
| HbA1c (> 8.3%) | The mean HbA1c was 8.70% (8.59 to 8.81) | MD 0.09% lower (0.34 lower to 0.15 higher) | 51,973 (234 RCTs) | ⨁⨁◯◯ Lowa,b | |||
| SBP (< or = to 136 mmHg) | The mean SBP was 130.66 mmHg (130.03 to 131.29) | MD 0.17 mmHg higher (1.82 lower to 1.46 higher) | 36,772 (125 RCTs) | ⨁⨁◯◯ Lowa,b | |||
| SBP (> 136 mmHg) | The mean SBP was 138.53 mmHg (137.74 to 139.30) | MD 0.20 mmHg lower (2.25 lower to 1.62 higher) | 59,285 (118 RCTs) | ⨁⨁◯◯ Lowa,b | |||
| LDL (< or = 107 mg/dL) | The mean LDL was 94.46 mg/dL (93.48 to 95.47) | MD 0.74 mg/dL higher (1.51 lower to 2.98 higher) | 64,072 (109 RCTs) | ⨁⨁◯◯ Lowa,b | |||
| LDL (> 107 mg/dL) | The mean LDL was 108.48 mg/dL (107.26 to 109.69) | MD 0.38 mg/dL lower (3.05 lower to 2.30 higher) | 41,207 (89 RCTs) | ⨁⨁◯◯ Lowa,b | |||
| Outcome | N received clinician reminders | N did not receive clinician reminders | N screened after receiving clinician reminders | N screened after not receiving clinician reminders | Odds ratio | № of participants (studies) | Certainty |
| Retinopathy screening | 3118 | 36,036 | 1752 | 14,575 | 1.10 (0.70 to 2.09) | 39,154 (58 RCTs) | ⨁◯◯◯ Very lowa,b,c |
| Foot screening | 2658 | 26,527 | 903 | 17,246 | 1.30 (0.71 to 2.57) | 29,185 (43 RCTs) | ⨁◯◯◯ Very lowa,b,c |
Patient or population: adults with diabetes (age 18+) Setting: outpatient care Intervention: clinician reminders Comparison: no clinician reminders
Duration of follow‐up (months) ‐ mean (range):
HbA1c:
Baseline < 8.3: 14.5 (3 to 36)
Baseline > 8.3: 10.8 (3 to 28)
SBP:
Baseline < 136: 16.5 (3 to 160)
Baseline ≥ 136: 15.4 (6 to 28)
LDL:
Baseline < 107: 15.8 (6 to 36)
Baseline ≥ 107: 14.9 (6 to 36)
Retinopathy screening: 13.9 (1 to 30)
Foot screening: 13.9 (1 to 24)
*The risk in the intervention group (and its 95% credible interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CrI).
CrI: credible interval; HbA1c: glycated haemoglobin; LDL: low‐density lipoprotein; MD: mean difference; OR: odds ratio; RCT: randomised controlled trial; SBP: systolic blood pressure
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
Explanations Average baseline risk for each study at baseline was defined as high or low using the median average value for studies as the cutoff.
Reporting of harms was too infrequent and was too variable to properly assess and therefore was not included in the summary of findings tables.
aRefers to the GRADE domain 'inconsistency'. We downgraded all findings for this due to the variation observed in parameter estimates.
bRefers to the GRADE domain 'indirectness'. We downgraded all findings for this due to parameters being estimated predominantly on indirect evidence and due to concerns about the applicability of these findings because of heterogeneity of interventions and populations (https://gdt.gradepro.org/app/handbook/handbook.html).
cRefers to the GRADE domain 'imprecision'. We downgraded only the screening outcome findings due to the small sample sizes for these outcomes, which led to imprecise findings in the meta‐regression.