Effects and Safety of Diabetic GUideline Algorithm Implementation Performed by Primary Care Physicians in the Community (GUARD)
Type 2 Diabetes, Cardiovascular Complication, Diabetic Kidney Disease
About this trial
This is an interventional treatment trial for Type 2 Diabetes focused on measuring Diabetes implementation study, Diabetes guideline algorithm, Cardiovascular disease, Chronic kidney disease
Eligibility Criteria
Inclusion Criteria:
- ①Males or females aged 65 and above (≥65) receive treatment from the local community health service center;
- ②Diagnosed type 2 diabetes (ADA criteria):
- A. Typical symptoms of diabetes + random blood sugar ≥ 11.1mmol/L;
- B. Fasting blood glucose (FPG) ≥ 7.0mmol/L (fasting blood glucose is defined as no caloric intake within 8 hours);
- C. Oral glucose tolerance test 2h blood glucose (OGTT) ≥ 11.1mmol/L (2h after meal);
- D. have been treated with antidiabetic drugs;
- Each blood sugar test must be repeated to confirm the diagnosis;
- ③Complicated with chronic kidney disease and/or very high/high risk of cardiovascular disease, meet any one of the following:
- A. ASCVD, including coronary heart disease, cerebral infarction, peripheral vascular disease;
- B. Or target organ damage (albuminuria, renal impairment with eGFR ≥ 30 ml/min/1.73m2, left ventricular hypertrophy or retinopathy);
- C. ≥ 3 major risk factors (age ≥ 65 years old, hypertension, dyslipidemia, smoking, obesity );
- D. Diabetes duration ≥ 10 years, with any one traditional cardiovascular risk factor such as advanced age, obesity, smoking, sedentary, family history of cardiovascular disease, hypertension, abnormal lipid metabolism.
Exclusion Criteria:
- ①Pregnant women or women planning to become pregnant;
- ②eGFR<30 mL/min/1.73m2 (CKD-EPI formula);
- ③Patient cannot be followed up for 36 months (due to health condition or migration);
- ④Unwilling or unable to sign the informed consent;
- ⑤Type 1 diabetes;
Sites / Locations
- Xiangcheng Second People's HospitalRecruiting
- Caohu Community Healthcare Center
- Huangqiao Community Healthcare Center
- Xiangcheng People's Hospital.Recruiting
- Yuanhe Community Healthcare CenterRecruiting
- Xiangcheng Third People's HospitalRecruiting
- Taiping Community Healthcare CenterRecruiting
- Yangchenghu People's Hospital
- Health Center of Xiangcheng Tourism Resort
- Caohu People's Hospital
- Dongqiao Community Healthcare CenterRecruiting
- Xiangcheng Traditional Chinese Medicine HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Intensive guideline algorithm implementation
Conventional guideline algorithm implementation
SGLT2i or GLP-1RA recommended in priority in subjects at very high/high CV risk. The targets of intervention will be achieved at HbA1C <7%, blood pressure <130/80mmHg, LDL-c<1.8mmol/L at very high CV risk or <2.6mmol/L at high CV risk patients, antiplatelet as secondary prevention of ASCVD.
Treatment based on the current approaches implemented by local physicians(primary care physicians). Guideline based education and consults will be conducted to primary care physicians.