The Alphabet strategy — a tool to achieve clinical trial standards in routine practice?

Abstract

The Steno-2 study and UKPDS showed that targeted intensified intervention on modifiable cardiovascular risk factors in patients with type 2 diabetes reduces morbidity and mortality. The Alphabet POEM strategy (Practice Of Evidence-based Medicine) assessed the effect of systematic application of the Alphabet Strategy to care of patients with type 2 diabetes. In comparison to the Steno-2 intensive cohort, Alphabet POEM fared similarly with regard to diastolic blood pressure (BP), HbA1C, aspirin and angiotensin-converting enzyme (ACE) inhibitor use, but less well with respect to systolic BP, total cholesterol and use of statins. Alphabet POEM achieved better systolic and diastolic BP than UKPDS but glycaemic control was significantly worse. The standards achieved in the Steno-2 study and UKPDS are in principle, at least, partially achievable in a district general hospital in the UK, but fully achieving them in practice will probably need a radical restructuring, and greater provision of resources.

Evaluation of a student-led interprofessional innovative health promotion model for an underserved population with diabetes: A pilot project

“…Topics included Advice, Blood pressure, Cholesterol, Diabetes control and care, Eye care, Foot care and Guardian drugs (Jaiveer et al, 2003). In this study, the Alphabet Strategy was modified by adding the topic of Dental Care and Diet as additional components of diabetes management.…”

“…Each month, the sessions focused on different letters in the Table I. Modified alphabet strategy -management targets (adapted from Jaiveer, Saraswathy, Lee, Morrissey, & Patel, 2003).…”

“…In the management of diabetes, previous studies have demonstrated significant decreases in glycosylated hemoglobin and non-HDL cholesterol among patients attending a primary care clinic implementing a team-based approach to care in an underserved urban community (Jaiveer et al, 2003;Janson et al, 2009;Piatt et al, 2006). This study utilized a modified version of the Alphabet Strategy to improve diabetes-related outcomes among patients at primary care outreach clinics serving medically underserved populations (Jaiveer et al, 2003).…”

“…However, achieving these standards in a traditional clinical practice setting can be challenging, particularly among underserved patient populations. Researchers in the UK developed an innovative approach to improving diabetes management (Jaiveer, Saraswathy, Lee, Morrissey, & Patel, 2003). In their study, outpatient diabetes education services were delivered utilizing a simplified template termed the Alphabet Strategy, a tool with targets similar to those used in randomized clinical trials (Table I).…”

“…This study utilized a modified version of the Alphabet Strategy to improve diabetes-related outcomes among patients at primary care outreach clinics serving medically underserved populations (Jaiveer et al, 2003).…”