Evidence map›Paper›PMID 34608564›Full record

Trial reportJournal of general internal medicine2022

HbA1c-Triggered Endocrinology Electronic Consultation for Type 2 Diabetes Management.

Andrew S Oseran, Karthik Rao, Yuchiao Chang, Wei He, Chrisanne E Sikora, Deborah J Wexler, Daniel M Horn

Registry-linked trialOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03542084 (Impact of Endocrinology Auto-triggered E-consults on Glycemic Control), which is not on this map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03542084 nacompletednot on this map

Impact of Endocrinology Auto-triggered E-consults on Glycemic Control

TypeinterventionalSponsorMassachusetts General HospitalRan2018 to 2020Enrolled305ConditionsDiabetes MellitusArmsUnsolicited endocrine e-consult
3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Review
  8. Review
  9. Formalizing the curbside: digitally enhancing access to specialty care.Proceedings (Baylor University. Medical Center) · 2023
    Article
  10. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Andrew S Oseran *Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.ORCID 0000-0002-5810-5927
Karthik Rao *Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge St. 16th Floor, Boston, MA, 02114, USA.
Yuchiao ChangDivision of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge St. 16th Floor, Boston, MA, 02114, USA.
Wei HeDivision of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge St. 16th Floor, Boston, MA, 02114, USA.
Chrisanne E SikoraPerformance Analysis and Improvement, Massachusetts General Physicians Organization, Boston, MA, USA.
Deborah J Wexler *Massachusetts General Hospital Diabetes Unit and Harvard Medical School, Boston, MA, USA.
Daniel M Horn *Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge St. 16th Floor, Boston, MA, 02114, USA. dmhorn@partners.org.
Harvard University · USMassachusetts General Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundElectronic consultation (eConsultation) offers a potential mechanism to increase access to specialty care, address knowledge gaps, and overcome therapeutic inertia in patients with type 2 diabetes (T2DM) being managed by primary care physicians (PCPs).

objectiveTo develop and implement a system to provide unsolicited endocrinology eConsult for T2DM patients with HbA1c 8.5-10.5% managed by PCPs.

designCluster-randomized matched cohort study with implementation evaluation.

participantsPCPs affiliated with Massachusetts General Hospital (MGH).

interventionsUnsolicited endocrinology eConsultation. MAIN MEASURES: The primary clinical outcome was mean change in HbA1c at 6 months. Secondary process outcomes included referral completion rate, prescription rates of glucose-lowering medications, differences in rate of other management recommendations, change in all glucose-lowering medications, and number of face-to-face endocrinology visits. KEY

results161 PCPs were randomly assigned to intervention (n=81) and control (n=80) arms. eConsultations were triggered on 130 patients from intervention arm PCPs. Intervention arm patients had a 0.89 (SD 1.45) decrease in HbA1c compared to 0.69 (SD 1.32) decrease in the control arm (p=0.28). There were significant differences in prescribing of glucose-lowering medications between arms. There was a 19.3% increase in patients prescribed GLP-1 RA or SGLT2i in the intervention arm compared to a 6.9% increase in control (p=0.003). There were also significant increases in prescription rates of metformin (3.1% vs -3.1%, p=0.03) and sulfonylureas (1.5% vs -6.9%, p=0.03). At 6-month follow-up, the intervention arm had 13 in-person endocrinology visits compared to 29 (p=0.012) in the control arm. PCPs were more likely to accept recommendations regarding adherence to or dose adjustment of current medications than initiation of new medications.

conclusionsThe implementation of an unsolicited endocrinology eConsult system for patients with poorly controlled T2DM is feasible. Unsolicited eConsultation was associated with increased prescribing of glucose-lowering medications without significant difference in HbA1c.

trial registrationClinicaltrials.gov registration: NCT03542084.

Indexed as

Diabetes Mellitus, Type 2MetforminRemote ConsultationCohort StudiesGlycated HemoglobinHumansGlycated HemoglobinMetforminelectronic consultationelectronic health recordhealthcare deliverytype 2 diabetes

Identifiers

PMID34608564
PMCPMC8971272
OpenAlexW3202881837

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.