Actively Recruiting

Phase Not Applicable
Age: 18Years - 90Years
All Genders
ID07124923

Effectiveness of a Continuous Care Intervention by the Endocrinology and Nutrition Service in Primary Care to Improve the Control of Type 2 Diabetes Mellitus in Terres de l'Ebre, Catalonia

Led by Institut Investigacio Sanitaria Pere Virgili · Updated on 2025-09-08

7792

Participants Needed

12

Research Sites

78 weeks

Total Duration

On this page

Sponsors

I

Institut Investigacio Sanitaria Pere Virgili

Lead Sponsor

F

Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Collaborating Sponsor

AI-Summary

What this Trial Is About

Researchers are evaluating a continuity of care intervention aimed at improving metabolic control in adults with type 2 diabetes mellitus (T2DM) in the Terres de l'Ebre health region. This randomized, parallel-group clinical trial is led by the Endocrinology Service at Hospital de Tortosa Verge de la Cinta and focuses on training primary care professionals through structured, multidisciplinary education and feedback. The study addresses challenges in managing T2DM including glycemic control and cardiovascular risk, with HbA1c as the primary marker. The intervention involves onsite training sessions delivered by endocrinologists and nurse educators to primary care physicians and nurses at selected centers. Training consists of six modules combining theoretical and practical content related to diabetes management, cardiovascular risk reduction, and diabetic foot care. These sessions occur biweekly over one year from July 2025 to July 2026, with each participating center receiving 15 sessions. Centers are randomized to either receive this training or continue usual care without the specific continuity-of-care training. Participants with T2DM will be assessed at baseline, 6, 12, and 24 months for HbA1c and secondary health outcomes like cholesterol levels, blood pressure, BMI, and adherence to screening protocols. The study also collects professional feedback through focus groups before and after the intervention to understand barriers and facilitators. Data are anonymized, and the study aims to provide evidence on the effectiveness of multidisciplinary care continuity in a primary care setting over a two-year follow-up period.

CONDITIONS

Brief Title

Continuous Care Intervention in Primary Care to Improve Type 2 Diabetes Control in Terres de l'Ebre, Catalonia

Who Can Participate

Age: 18Years - 90Years
All Genders

Eligibility Criteria

Eligible

You may qualify if you...

  • Adults aged 18 years or older
  • Active diagnosis of type 2 diabetes mellitus documented in the eCAP primary care electronic health record system
  • Duration of type 2 diabetes mellitus of at least 12 months as of January 2025
Not Eligible

You will not qualify if you...

  • Diagnosis of type 1 diabetes mellitus
  • Type 2 diabetes managed by a specialist at the time of inclusion
  • Current treatment with systemic corticosteroids
  • Active malignancy (neoplasia)
  • Gestational diabetes
  • Pregnancy or breastfeeding
  • Advanced chronic disease with life expectancy less than 1 year (MACA)
  • Complex chronic patients (CCP)
  • Diagnosis of dementia
  • Institutionalized patients or residents in social healthcare facilities
  • Age under 18 years
  • Age over 90 years
  • Severe psychiatric illness (e.g., psychosis, bipolar disorder, major depression)
  • History of kidney transplant
  • Undergoing dialysis
  • History of alcohol or drug abuse

AI-Screening

AI-Powered Screening

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Your Study Journey

Screening

Duration - 2 to 4 weeks

Participants are screened for eligibility to participate in the trial.

Continuity-of-Care Training

Duration - 12 months

Participants receive a structured, multidisciplinary training and feedback program delivered by endocrinologists and nurse educators to primary care physicians and nurses to improve management of type 2 diabetes.

Biweekly sessions totaling 15 per year at each primary care center

Data Collection and Follow-up

Duration - 24 months

Participants’ health indicators and clinical outcomes are monitored and recorded at baseline, 6, 12, and 24 months after enrollment to assess the effectiveness of the intervention.

4 visits (baseline, 6, 12, and 24 months)

Trial Site Locations

Total: 12 locations

1

Abs Amposta

Amposta, Tarragona, Spain, 43870

Actively Recruiting

2

Abs Deltebre

Deltebre, Tarragona, Spain, 43580

Actively Recruiting

3

Abs Ametlla-Perelló

El Perelló, Tarragona, Spain, 43860

Actively Recruiting

4

ABS FLIX

Flix, Tarragona, Spain, 43750

Actively Recruiting

5

Abs Gandesa

Gandesa, Tarragona, Spain, 43780

Actively Recruiting

6

Abs Ampolla-Aldea

L'Ampolla, Tarragona, Spain, 43895

Actively Recruiting

7

Abs Mora La Nova

Móra la Nova, Tarragona, Spain, 43770

Actively Recruiting

8

Abs La Ràpita-Alcanar

Sant Carles de la Ràpita, Tarragona, Spain, 43540

Actively Recruiting

9

Abs Tortosa Est

Tortosa, Tarragona, Spain, 43500

Actively Recruiting

10

Abs Tortosa Oest

Tortosa, Tarragona, Spain, 43500

Actively Recruiting

11

Hospital de Tortosa Verge de la Cinta

Tortosa, Tarragona, Spain, 43500

Actively Recruiting

12

Abs Ulldecona

Ulldecona, Tarragona, Spain, 43550

Actively Recruiting

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Research Team

M

Marcela Miret Llauradó, MD

How is the study designed?

Study Type

INTERVENTIONAL

Masking

TRIPLE

Allocation

RANDOMIZED

Model

PARALLEL

Primary Purpose

OTHER

Number of Arms

2

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