Continuous Care Intervention in Primary Care to Improve Type 2 Diabetes Control in Terres de l'Ebre, Catalonia

NCT ID: NCT07124923

Last Updated: 2025-09-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

7792 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-20

Study Completion Date

2027-07-20

Brief Summary

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This randomized, parallel-group clinical trial evaluates the effectiveness of a continuity of care intervention to improve metabolic control in adults with type 2 diabetes mellitus (T2DM) in the Terres de l'Ebre health region. The intervention, led by the Endocrinology Service at Hospital de Tortosa Verge de la Cinta (HTVC), involves structured, multidisciplinary training and feedback provided by endocrinologists and nurse educators to primary care professionals. Training modules combine theoretical and practical content focused on current diabetes management.

Primary care centers are randomized to intervention or control arms. Eligible participants are adult patients with an active diagnosis of T2DM for at least 12 months as of January 2025, registered in the eCAP system. All primary care professionals in intervention centers participate in the training.

The intervention is conducted over one year (July 2025-July 2026). Outcomes are assessed at baseline, 6, 12, and 24 months. The primary outcome is HbA1c; secondary outcomes include other health indicators, professional knowledge and engagement, and organizational variables. A qualitative component gathers professional input before and after the intervention to inform future implementation. All data are anonymized to ensure confidentiality.

Detailed Description

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T2DM is a highly prevalent chronic disease, accounting for approximately 90% of all diabetes cases, and is primarily managed in the primary care setting. The complexity of optimizing metabolic control in T2DM has increased, as current guidelines recommend a multifactorial approach that addresses not only glycemic control but also cardiovascular risk and multimorbidity. Glycosylated hemoglobin (HbA1c) remains the principal marker for assessing glycemic control and predicting diabetes-related complications.

Despite the availability of evidence-based clinical practice guidelines, their implementation in routine care is often suboptimal due to factors such as limited time, resources, clinical inertia, and challenges with patient adherence. Interventions targeting healthcare professionals and organizational processes-such as structured training, audit and feedback, and system-level changes-have shown promise in improving metabolic outcomes, particularly among patients with suboptimal glycemic control.

This study is a randomized, parallel-group clinical trial designed to evaluate the effectiveness of a continuity of care intervention led by the Endocrinology Service at HTVC, in collaboration with primary care centers in the Terres de l'Ebre health region. Primary care centers will be randomized to either the intervention or control group.

The intervention consists of structured, multidisciplinary training and feedback provided by endocrinologists and nurse educators to primary care physicians and nurses. Training sessions are delivered in modules that combine theoretical and practical content, with a focus on up-to-date diabetes management strategies and the needs of each primary care center. The endocrinology team includes endocrinologists, nurse educators, and a specialist nurse from the Diabetic Foot Unit. Training will be delivered onsite at intervention centers in scheduled sessions over a one-year period.

A qualitative component is integrated into the study, involving focus groups with participating primary care professionals before and after the intervention. This aims to gather insights on professional perspectives, identify barriers and facilitators, and inform the adaptation and future implementation of the intervention.

The primary outcome is improvement in HbA1c, with secondary outcomes including additional patient health indicators, professional knowledge and engagement, and organizational variables. Data collection will occur at baseline, 6, 12, and 24 months. All data will be anonymized to ensure confidentiality.

This study aims to provide evidence on the effectiveness of a multidisciplinary, continuity of care intervention in improving metabolic control for adults with T2DM in a real-world primary care setting.

Conditions

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Diabetes Mellitus Type 2

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
The study will maintain blinding for participating patients, the data manager, the principal investigator, the statistician and the rest of the research team members. However, the primary care professionals who will receive the intervention, the trainers, those responsible for data extraction and the members of the training committee will not be blinded.

Study Groups

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Continuity-of-Care Training for Primary Care Professionals

A parallel-group randomized clinical trial will be conducted in 11 primary care centers of the Terres de l'Ebre area (Catalan Health Institute). Randomization was performed by the data extractor before pseudonymization using simple randomization (1:1 ratio), generating values 0 and 1. Centers scoring \<0.5 were assigned to the control group; those ≥0.5 to the intervention group, resulting in 5 intervention and 6 control centers.

Group Type EXPERIMENTAL

Continuity-of-Care intervention

Intervention Type OTHER

The intervention is a structured, multidisciplinary training and feedback program led by the Endocrinology Service at HTVC in collaboration with primary care centers in Terres de l'Ebre.

Four endocrinologists and four nurses (three educators and one diabetic foot referent) will provide onsite training to primary care physicians and nurses. Training includes six modules with theoretical and practical components, covering T2DM management, cardiovascular risk reduction, and diabetic foot care. Sessions will be held biweekly and delivered by doctor-nurse teams rotating through the participating primary care centers from July 2025 to July 2026, with each center receiving a total of 15 sessions per year.

The program also includes regular feedback to professionals on clinical performance and patient outcomes, adapting content to each center's needs. A qualitative component, involving focus groups before and after the intervention, will gather feedback and inform future implementation.

Usual Care (No Continuity-of-Care Training)

Primary care professionals provide care according to current local standard practices without receiving specific training on continuity-of-care strategies.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Continuity-of-Care intervention

The intervention is a structured, multidisciplinary training and feedback program led by the Endocrinology Service at HTVC in collaboration with primary care centers in Terres de l'Ebre.

Four endocrinologists and four nurses (three educators and one diabetic foot referent) will provide onsite training to primary care physicians and nurses. Training includes six modules with theoretical and practical components, covering T2DM management, cardiovascular risk reduction, and diabetic foot care. Sessions will be held biweekly and delivered by doctor-nurse teams rotating through the participating primary care centers from July 2025 to July 2026, with each center receiving a total of 15 sessions per year.

The program also includes regular feedback to professionals on clinical performance and patient outcomes, adapting content to each center's needs. A qualitative component, involving focus groups before and after the intervention, will gather feedback and inform future implementation.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Enrollment will begin in July 2025, aligned with the initiation of training sessions for healthcare professionals (physicians and nurses).

Eligible participants must:

* Be adults (≥18 years old)
* Have an active diagnosis of T2DM documented in the eCAP primary care electronic health record system
* Have a duration of T2DM of at least 12 months as of January 2025

Exclusion Criteria

* Diagnosis of type 1 diabetes mellitus (T1DM)
* T2DM managed by a specialist at the time of inclusion
* Current treatment with systemic corticosteroids
* Active neoplasia (malignancy)
* Gestational diabetes
* Pregnancy or breastfeeding
* Diagnosis of MACA (advanced chronic disease with life expectancy \<1 year)
* Complex chronic patients (CCP)
* Diagnosis of dementia
* Institutionalized patients or those residing in social healthcare facilities
* Age over 90 years
* Age under 18 years
* Severe psychiatric illness (e.g., psychosis, bipolar disorder, major depression)
* History of kidney transplant
* Undergoing dialysis
* History of alcohol or drug abuse
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

OTHER

Sponsor Role collaborator

Institut Catala de Salut

OTHER_GOV

Sponsor Role collaborator

Institut Investigacio Sanitaria Pere Virgili

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marcela Miret Llauradó, MD

Role: PRINCIPAL_INVESTIGATOR

Catalan Institute of Health

Locations

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Abs Amposta

Amposta, Tarragona, Spain

Site Status RECRUITING

Abs Deltebre

Deltebre, Tarragona, Spain

Site Status RECRUITING

Abs Ametlla-Perelló

El Perelló, Tarragona, Spain

Site Status RECRUITING

ABS FLIX

Flix, Tarragona, Spain

Site Status RECRUITING

Abs Gandesa

Gandesa, Tarragona, Spain

Site Status RECRUITING

Abs Ampolla-Aldea

L'Ampolla, Tarragona, Spain

Site Status RECRUITING

Abs Mora La Nova

Móra la Nova, Tarragona, Spain

Site Status RECRUITING

Abs La Ràpita-Alcanar

Sant Carles de la Ràpita, Tarragona, Spain

Site Status RECRUITING

Abs Tortosa Est

Tortosa, Tarragona, Spain

Site Status RECRUITING

Abs Tortosa Oest

Tortosa, Tarragona, Spain

Site Status RECRUITING

Hospital de Tortosa Verge de la Cinta

Tortosa, Tarragona, Spain

Site Status RECRUITING

Abs Ulldecona

Ulldecona, Tarragona, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Marcela Miret Llauradó, MD

Role: CONTACT

+0034977519100 ext. 2269

Facility Contacts

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Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel·la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel·la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel·la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel.la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel·la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Marcel·la Miret Llauradó

Role: primary

+34-977519100 ext. 2269

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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2024 DI 00039

Identifier Type: OTHER

Identifier Source: secondary_id

009/2024

Identifier Type: -

Identifier Source: org_study_id

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