Table 3: GRADE Quality Assessment for Specialized Multidisciplinary Community Care for Management of Type 2 Diabetes.
| Intervention* | # of Studies |
Quality Assessment | Summary of Findings | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. of Patients | Effect (Mean Difference [95% CI])* |
Quality | ||||||||
| Design | Quality | Consistency | Directness | Other | Int* | Control | ||||
| Outcome: Glycosylated Hemoglobin (HbA1c) | ||||||||||
|
At least a RN, RD and MD |
4 |
RCT High |
Serious limitations† Moderate |
Consistent Moderate |
Direct Moderate |
None Moderate |
341 |
313 |
-1.00 [-1.27, -0.73] |
Moderate |
|
At least a pharmacist and PCP |
2 |
RCT High |
No serious limitations High |
Consistent High |
Direct High |
None‡ High |
148 |
134 |
-1.05 [-1.57, -0.52] |
High |
| Outcome: Systolic Blood Pressure | ||||||||||
|
At least a RN, RD and MD |
2 |
RCT High |
Serious limitations§ Moderate |
Unexplained heterogeneity Low |
Direct Low |
Imprecise or sparse data Unlikely publication bias Very-low |
133 |
197 |
-2.04 [-13.80, 9.74] |
Very-low |
|
At least a pharmacist and PCP |
RCT High |
Serious limitations¥ Moderate |
Consistent Moderate |
Direct Moderate |
None Moderate |
214 |
214 |
-7.13 [-11.78, -2.48] |
Moderate |
|
MD, primary care physician and/or diabetes specialist; PCP, primary care physician; RD, registered dietician; RN, registered nurse; CI, confidence interval; Int, intervention; RCT, randomized controlled trial.
Unclear allocation concealment in 2 studies (12;13); potential for control group contamination in 1 study, where the same physician provided care to intervention and control groups (14); > 30% loss to follow-up in 1 study (12); not analyzed using intention-to-treat in 2 studies (12;15); frequency of testing of HbA1c amongst controls may have effected improvement in glycemic control in 1 study. (14)
Studies were powered to detect a change in HbA1c.
Unclear allocation concealment in 1 study (16); not analyzed using intention-to-treat in 1 study (15); not powered to detect a change in blood pressure in both studies (15;16); no description of methods for obtaining blood pressure measurement in 1 study. (16)
All blood pressure outcome assessment were obtained by automated blood pressure monitors; however, blinding of outcome assessor in only 1 study (17); description of frequency and methods for obtaining blood pressure measurement in only 1 study (18), where an average of 5 measurements were taken 1 minute apart