The Microalbuminuria Education Medication and Optimisation (MEMO) study: Four years follow up of multifactorial intervention in high risk individuals with type 2 diabetes.

Aims

The Microalbuminuria Education Medication and Optimisation (MEMO) study, revealed improved cardiovascular risk and glycaemic control with 18 months of intensive multifactorial intervention in high‐risk people with type 2 diabetes, without any increase in severe hypoglycaemia. Our aim was to assess longer‐term outcomes at 4‐year follow‐up in these participants.

Methods

Some 189 individuals with type 2 diabetes and microalbuminuria were recruited from a multi‐ethnic population in Leicestershire, UK. The intervention group (n = 95) received multifactorial intervention with self‐management education, and the control group (n = 94) received usual care. The primary outcome was change in HbA1c, and secondary outcomes were blood pressure (BP), cholesterol, microalbuminuria, estimated GFR, cardiovascular risk scores and major adverse cardiovascular events.

Results

Some 130 participants (68.7%), mean (sd) age 60.8 (10.4) years, duration of diabetes 11.5 (9.7) years, completed 4 years of follow‐up. Mean change [95% confidence intervals (CI)] in HbA1c over 4 years was greater with intensive intervention compared with control (−3 mmol/mol, 95% CI −4.95,−1.11; −0.4%, 95% CI −0.67,−0.15; P = 0.002). Significant improvements over the 4 years were also seen in systolic BP (−7.3 mmHg, 95% CI −11.1, −3.5; P < 0.001), diastolic BP (−2.9 mmHg, 95% CI −5.4, −0.3; P = 0.026), cholesterol (−0.3 mmol/l, 95% CI −0.52,−0.12; P = 0.002), and 10‐year coronary heart disease (−5.3, 95% CI −8.2,−2.3; P < 0.001) and stroke risk (−4.4, 95% CI −7.5, −1.3; P < 0.001).

Conclusion

Multifactorial intervention with structured diabetes self‐management education compared with usual diabetes care has benefits for cardio‐metabolic risk factor profile. There was no increase in severe hypoglycaemia and cardiovascular mortality despite intensive glycaemic control, although the study was not powered to assess these outcomes.