Improving glycaemic control of patients with type 2 diabetes mellitus (T2DM) through management by a community based, multidisciplinary, integrated primary care / specialist level care service.

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This research aims to improve quality of life in patients with type 2 diabetes by building the capacity of primary care and providing accessible, evidence based care in the community through multidisciplinary collaboration and integration across the primary and tertiary interface. The primary objective of this research is to investigate if glycaemic control of patients with type 2 diabetes can be improved through management at the Inala Chronic Disease Management Service (ICDMS) relative to comparable patients receiving usual care at the PAH endocrinology outpatients clinic. Other important objectives of the research include: * To improve modifiable cardiovascular risk factors and microvascular complications of diabetes * To increase the capacity and scope of primary care to manage patients with type 2 diabetes * To restructure the organisation of care in order to improve the effectiveness of patient care * To develop a sustainable model of care that is generalisable to other chronic diseases. * To investigate the relative costs of the new model of care * To assess the acceptability to GPs of the ICDMS caring for patients traditionally referred to the specialist outpatients clinic * To assess the acceptability to patients of the ICDMS rather than usual care at a specialist outpatients clinic. A key component of the ICDMS will be the staged devolution of diabetes services from tertiary care to primary care through increasing the capacity of primary care to meet the needs of patients who would otherwise use hospital outpatient clinic services. Initially, the tertiary level service providers (particularly the endocrinologist) will be heavily involved in training, support and service provision. Their involvement will gradually decrease to a virtual consultative function interspersed with limited patient contact. The proposed research is a structured and rational approach to evaluating the efficaciousness and effectiveness of the ICDMS. To achieve this, an open controlled trial of patient care at the ICDMS compared with usual care at the PAH diabetes outpatient clinic is proposed. Additionally, a nested cluster randomized controlled trial is proposed to test the effectiveness of the upskilling component of the project – general practices will be randomised to either receive the upskilling immediately or to be a wait-listed control group.