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Med."],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>The Microalbuminuria Education Medication and Optimisation (<jats:styled-content style=\"fixed-case\">MEMO<\/jats:styled-content>) study, revealed improved cardiovascular risk and glycaemic control with 18\u00a0months of intensive multifactorial intervention in high\u2010risk people with type 2 diabetes, without any increase in severe hypoglycaemia. Our aim was to assess longer\u2010term outcomes at 4\u2010year follow\u2010up in these participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Some 189 individuals with type 2 diabetes and microalbuminuria were recruited from a multi\u2010ethnic population in Leicestershire, <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>. The intervention group (<jats:italic>n<\/jats:italic>\u00a0=\u00a095) received multifactorial intervention with self\u2010management education, and the control group (<jats:italic>n<\/jats:italic>\u00a0=\u00a094) received usual care. The primary outcome was change in HbA<jats:sub>1c<\/jats:sub>, and secondary outcomes were blood pressure (<jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>), cholesterol, microalbuminuria, estimated <jats:styled-content style=\"fixed-case\">GFR<\/jats:styled-content>, cardiovascular risk scores and major adverse cardiovascular events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Some 130 participants (68.7%), mean (<jats:sc>sd<\/jats:sc>) age 60.8 (10.4) years, duration of diabetes 11.5 (9.7) years, completed 4\u00a0years of follow\u2010up. Mean change [95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>)] in HbA<jats:sub>1c<\/jats:sub> over 4\u00a0years was greater with intensive intervention compared with control (\u22123\u00a0mmol\/mol, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22124.95,\u22121.11; \u22120.4%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22120.67,\u22120.15; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002). Significant improvements over the 4\u00a0years were also seen in systolic <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> (\u22127.3\u00a0mmHg, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u221211.1, \u22123.5; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), diastolic <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> (\u22122.9\u00a0mmHg, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22125.4, \u22120.3; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.026), cholesterol (\u22120.3\u00a0mmol\/l, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22120.52,\u22120.12; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002), and 10\u2010year coronary heart disease (\u22125.3, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22128.2,\u22122.3; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and stroke risk (\u22124.4, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22127.5, \u22121.3; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Multifactorial intervention with structured diabetes self\u2010management education compared with usual diabetes care has benefits for cardio\u2010metabolic 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14134","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T19:05:09Z","timestamp":1568142309000},"page":"286-297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The Microalbuminuria Education Medication and Optimisation (<scp>MEMO<\/scp>) study: 4 years follow\u2010up of multifactorial intervention in high\u2010risk individuals with type 2 diabetes"],"prefix":"10.1111","volume":"37","author":[{"given":"W.","family":"Crasto","sequence":"first","affiliation":[{"name":"Diabetes Research Centre University of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3353-1863","authenticated-orcid":false,"given":"A. 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