We recruited patients with type 2 diabetes who had no history of cardiovascular disease or renal disease. All patients were aged 35-75 years and attending a hospital outpatient clinic. We recruited 323 patients (167 men and 156 women) attending the clinic consecutively. Patients were seen by one of six doctors who were unaware of the ongoing project. We allocated patients alternately to the experimental and control groups (162 experimental, 161 control), and all doctors saw an equal number of experimental and control patients. The University of Dundee special study module subcommittee approved this project on behalf of Tayside Committee on Medical Research Ethics.
We calculated New Zealand cardiovascular risk scores for all patients.5
These were clearly documented at the front of the notes of patients in the experimental group only. Standard information, such as weight; glycated haemoglobin, urinary microalbumin, and total and high density lipoprotein cholesterol concentrations; and blood pressure was available for all patients in both groups.
Only 42 patients (13%) had a low risk for a cardiovascular event (<10% five year risk), with 113 (35%) having moderate risk (10-20% risk) and 168 (52%) a high risk (>20% risk). Overall, there were no significant differences between control and experimental groups in the primary outcome measures (table): change of diabetes treatment (36% v 42%), lipid lowering drugs (9% v 12%), or blood pressure drugs (10% v 16%) and referral to dietician (13% v 10%). There were no differences in other interventions between the control and experimental groups. Among high risk patients, however, those in the experimental group were more likely to be prescribed blood pressure and lipid lowering drugs than those in the control group (P<0.02, Mantel-Haenszel test). Despite this difference, the time until the next hospital outpatient appointment was the same in the two groups, with 24% in each group (39 in the experimental group and 38 in the control group) receiving an appointment in less than six months.