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Trial registered on ANZCTR
Registration number
ACTRN12612000380897
Ethics application status
Approved
Date submitted
2/04/2012
Date registered
3/04/2012
Date last updated
19/07/2016
Type of registration
Prospectively registered
Titles & IDs
Public title
A randomised trial of a novel model of diabetes care for adults in the community through multidisciplinary collaboration and integration across the primary and tertiary interface
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Scientific title
Comparison of a novel model of community care versus usual care on glycaemic control in adults with type 2 diabetes: a randomised trial
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Secondary ID [1]
280100
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nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Type 2 diabetes
286013
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Condition category
Condition code
Metabolic and Endocrine
286201
286201
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0
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Diabetes
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Public Health
286431
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0
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Health service research
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This intervention is based on a novel concept which incorporates the principle of General Practitioners (GPs) with special interests around a multidisciplinary and coordinated approach to diabetes care in the community. This model of care includes a specialist doctor (endocrinologist), who acts in a consulting capacity to the GP, to endorse the GPs patient management plan. The intervention is delivered face to face with their advanced GP as well as with a diabetes nurse educator. This intervention will include follow up appointments which will be approximately every 6 weeks and will continue until 12 months.
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Intervention code [1]
284425
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Treatment: Other
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Comparator / control treatment
Usual care for patients with complex type 2 diabetes is in an endocrinology and diabetes outpatients settings at a secondary or tertiary hospital. Typically patient care is delivered prodominantly by a consultant doctor (an endocrinologist).
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Control group
Active
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Outcomes
Primary outcome [1]
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glycaemic control (as measured by HbA1c)
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Assessment method [1]
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Timepoint [1]
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6 months
12 months
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Secondary outcome [1]
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blood pressure
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Assessment method [1]
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Timepoint [1]
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6 months
12 months
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Secondary outcome [2]
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cholesterol and cholesterol fractions
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Assessment method [2]
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Timepoint [2]
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6 months
12 months
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Secondary outcome [3]
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Body mass index
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Assessment method [3]
296886
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Timepoint [3]
296886
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6 months
12 months
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Secondary outcome [4]
296887
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proportion of patients ceased smoking, collected by patient self-report on questionnaire
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Assessment method [4]
296887
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Timepoint [4]
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6 months
12 months
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Secondary outcome [5]
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foot complications including presence of diabetic ulcers/sores, partial or total foot amputation, charcot joint, delayed healing times for injured skin, neuropathic symptoms, pulses present in right and left foot (determined by assessment from podiatrist)
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Assessment method [5]
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Timepoint [5]
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6 months
12 months
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Secondary outcome [6]
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retinopathy complications (determined by patient medical records data)
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Assessment method [6]
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Timepoint [6]
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6 months
12 months
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Secondary outcome [7]
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microalbuminuria (determined by urine analysis to calculate albumuria to creatinine ratio and compared to reference range)
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Assessment method [7]
296890
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Timepoint [7]
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6 months
12 months
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Secondary outcome [8]
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serum creatinine
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Assessment method [8]
296891
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Timepoint [8]
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6 months
12 months
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Secondary outcome [9]
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hospitalisations for diabetic related complications (determined by data linkage to external database Queensland Hospital Admitted Patients Data Collection (QHAPDC))
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Assessment method [9]
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Timepoint [9]
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6 months
12 months
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Secondary outcome [10]
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proportion of patients achieving clinical target for HbA1c (at less than or equal to 7%) measured by blood pathology testing
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Assessment method [10]
296893
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Timepoint [10]
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6 months
12 months
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Secondary outcome [11]
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proportion of patients achieving clinical target for blood pressure (at less than or equal to 130/80 mm/Hg) measured in seated position with digital sphygmomanometer
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Assessment method [11]
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Timepoint [11]
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6 months
12 months
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Secondary outcome [12]
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proportion of patients achieving clinical target for low density lipoprotein (at less than or equal to 2.5 mmol/L) measured by blood pathology testing
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Assessment method [12]
296895
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Timepoint [12]
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6 months
12 months
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Eligibility
Key inclusion criteria
greater than 18 years
type 2 diabetes
referred to secondary/tertiary hospital diabetes outpatients for care
residing in the geographical area of interest in Brisbane, Australia
able to provide informed consent
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
patients without hypoglycaemic awareness
pregnancy
receiving haemodialysis
patients with terminal illness with life expectancy less than 2 years
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The person who determines if a patient is eligible to participate is unaware of the allocation group at the time of enrolment. Randomisation to group is conducted after eligibility is confirmed and consent has been provided from the patient.
Allocation to treatment group is done off site by the study statistician who is removed from the screening of participants.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomisation will use a weighted control of 3 intervention to 1 control. The randomisation will be done via web based computer randomisation, which is set up by the study statistician remotely.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
multi site
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/06/2012
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Actual
27/11/2012
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Date of last participant enrolment
Anticipated
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Actual
14/07/2015
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Date of last data collection
Anticipated
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Actual
31/12/2016
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Sample size
Target
400
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Accrual to date
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Final
352
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Recruitment in Australia
Recruitment state(s)
QLD
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Council
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Address [1]
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
284856
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Australia
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Primary sponsor type
Individual
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Name
Professor Claire Jackson
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Address
Discipline of General Practice
School of Medicine
The University of Queensland
Level 8, Health Science Building
Royal Brisbane and Women's Hospital
Herston QLD 4029
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Associate Professor Anthony Russell
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Address [1]
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Department of Diabetes and Endocrinology
Princess Alexandra Hospital
199 Ipswich Road
Woolloongabba QLD 4102
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Country [1]
283735
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
287033
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Metro South Human Research Ethics Committee
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Ethics committee address [1]
287033
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Ethics committee country [1]
287033
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Date submitted for ethics approval [1]
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12/04/2012
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Approval date [1]
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31/05/2012
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Ethics approval number [1]
287033
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Summary
Brief summary
Diabetes is a chronic disease where the primary care physician has a central role to play. Historically, evidence has supported the role of diabetes teams in hospital settings being able to provide better care compared with primary care but it has been argued whether this relates to improved systematic and organised care, compared to increased expert knowledge. With appropriate support and recall systems, delivery of diabetes care in general practice can be as good as hospital outpatient care. Recognising this, the United Kingdom has seen the introduction of diabetes clinics conducted by general practitioners with special interests (GPSIs) with demonstrated favourable improvements in HbA1c, cholesterol and blood pressure. To date, Australia has not adopted GPSIs into clinical practice. However, the Australian health care system is facing significant reform aimed at shifting the focus from tertiary and secondary hospital health care to primary health care, including the move towards GP superclinics. This research project focusses on the care of patients with complex T2DM who have been referred by their GPs for specialist diabetes care. This research is based on a novel concept which incorporates the principle of GPs with special interests around a multidisciplinary and coordinated approach to diabetes care in the community. Important to this model is the role of the specialist Endocrinologist in a consulting capacity to review and endorse the advanced skill GPs (GP Clinical Fellows) management plan. Few studies have investigated the staged devolution of diabetes services from secondary/tertiary care to primary care through increasing the capacity of primary care to meet the needs of patients who would otherwise use hospital outpatient services.
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Trial website
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Trial related presentations / publications
Askew DA, Jackson CL, Ware RS, Russell A. Protocol and baseline data from The Inala Chronic Disease Management Service evaluation study: a health services intervention study for diabetes care. BMC Health Services Research 2010;10:134. Jackson, Claire, Tsai, Jane, Brown, Cathy, Askew, Deborah and Russell, Anthony (2010) GPs with special interests impacting on complex diabetes care. Australian Family Physician, 39 12: 972974.
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Public notes
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Contacts
Principal investigator
Name
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Prof Claire Jackson
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Address
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Discipline of General Practice The School of Medicine The University of Queensland Level8, Health Sciences Building Royal Brisbane and Women's Hospital Herston 4029 QLD
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Country
33884
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Australia
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Phone
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+61 7 3365 5381
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Dr Maria Donald
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Address
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Discipline of General Practice
The School of Medicine
The University of Queensland
Level8, Health Sciences Building
Royal Brisbane and Women's Hospital
Herston 4029 QLD
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Country
17131
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Australia
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Phone
17131
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+61 7 3346 5135
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Fax
17131
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+61 7 3346 5178
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Email
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[email protected]
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Contact person for scientific queries
Name
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Professor Claire Jackson
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Address
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Discipline of General Practice
The School of Medicine
The University of Queensland
Level8, Health Sciences Building
Royal Brisbane and Women's Hospital
Herston 4029 QLD
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Country
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Australia
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Phone
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+61 7 3365 5381
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Fax
8059
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+61 7 3346 5178
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Clinical outcomes of an integrated primary-secondary model of care for individuals with complex type 2 diabetes: a non-inferiority randomised controlled trial.
2019
https://dx.doi.org/10.1007/s00125-018-4740-x
N.B. These documents automatically identified may not have been verified by the study sponsor.
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