Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages : a randomised controlled trial
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVE: We aimed to test the hypothesis that automated fibrosis score calculation and electronic reminder messages could increase the detection of advanced liver disease in patients with type 2 diabetes.
DESIGN: In this pragmatic randomised controlled trial at five general medical or diabetes clinics in Hong Kong and Malaysia, we randomly assigned patients in a 1:1 ratio to the intervention group with Fibrosis-4 index and aspartate aminotransferase-to-platelet ratio index automatically calculated based on routine blood tests, followed by electronic reminder messages to alert clinicians of abnormal results, or the control group with usual care. The primary outcome was the proportion of patients with increased fibrosis scores who received appropriate care (referred for hepatology care or specific fibrosis assessment) within 1 year.
RESULTS: Between May 2020 and Oct 2021, 1379 patients were screened, of whom 533 and 528 were assigned to the intervention and control groups, respectively. A total of 55 out of 165 (33.3%) patients with increased fibrosis scores in the intervention group received appropriate care, compared with 4 of 131 (3.1%) patients in the control group (difference 30.2% (95% CI 22.4% to 38%); p<0.001). Overall, 11 out of 533 (2.1%) patients in the intervention group and 1 out of 528 (0.2%) patients in the control group were confirmed to have advanced liver disease (difference 1.9% (95% CI 0.61% to 3.5%); p=0.006).
CONCLUSION: Automated fibrosis score calculation and electronic reminders can increase referral of patients with type 2 diabetes and abnormal fibrosis scores at non-hepatology settings.
TRIAL REGISTRATION NUMBER: NCT04241575.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:72 |
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| Enthalten in: |
Gut - 72(2023), 12 vom: 24. Nov., Seite 2364-2371 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhang, Xinrong [VerfasserIn] |
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| Links: |
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| Themen: |
CIRRHOSIS |
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| Anmerkungen: |
Date Completed 27.11.2023 Date Revised 14.12.2023 published: Electronic ClinicalTrials.gov: NCT04241575 Citation Status MEDLINE |
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| doi: |
10.1136/gutjnl-2023-330269 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360496350 |
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| 245 | 1 | 0 | |a Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages |b a randomised controlled trial |
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| 500 | |a ClinicalTrials.gov: NCT04241575 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVE: We aimed to test the hypothesis that automated fibrosis score calculation and electronic reminder messages could increase the detection of advanced liver disease in patients with type 2 diabetes | ||
| 520 | |a DESIGN: In this pragmatic randomised controlled trial at five general medical or diabetes clinics in Hong Kong and Malaysia, we randomly assigned patients in a 1:1 ratio to the intervention group with Fibrosis-4 index and aspartate aminotransferase-to-platelet ratio index automatically calculated based on routine blood tests, followed by electronic reminder messages to alert clinicians of abnormal results, or the control group with usual care. The primary outcome was the proportion of patients with increased fibrosis scores who received appropriate care (referred for hepatology care or specific fibrosis assessment) within 1 year | ||
| 520 | |a RESULTS: Between May 2020 and Oct 2021, 1379 patients were screened, of whom 533 and 528 were assigned to the intervention and control groups, respectively. A total of 55 out of 165 (33.3%) patients with increased fibrosis scores in the intervention group received appropriate care, compared with 4 of 131 (3.1%) patients in the control group (difference 30.2% (95% CI 22.4% to 38%); p<0.001). Overall, 11 out of 533 (2.1%) patients in the intervention group and 1 out of 528 (0.2%) patients in the control group were confirmed to have advanced liver disease (difference 1.9% (95% CI 0.61% to 3.5%); p=0.006) | ||
| 520 | |a CONCLUSION: Automated fibrosis score calculation and electronic reminders can increase referral of patients with type 2 diabetes and abnormal fibrosis scores at non-hepatology settings | ||
| 520 | |a TRIAL REGISTRATION NUMBER: NCT04241575 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a CIRRHOSIS | |
| 650 | 4 | |a DIABETES MELLITUS | |
| 650 | 4 | |a FATTY LIVER | |
| 650 | 4 | |a HEPATIC FIBROSIS | |
| 650 | 4 | |a PRIMARY CARE | |
| 700 | 1 | |a Yip, Terry Cheuk-Fung |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Grace Lai-Hung |e verfasserin |4 aut | |
| 700 | 1 | |a Leow, Wei-Xuan |e verfasserin |4 aut | |
| 700 | 1 | |a Liang, Lilian Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Lee-Ling |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Guanlin |e verfasserin |4 aut | |
| 700 | 1 | |a Ibrahim, Luqman |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Huapeng |e verfasserin |4 aut | |
| 700 | 1 | |a Lai, Jimmy Che To |e verfasserin |4 aut | |
| 700 | 1 | |a Chim, Angel Mei-Ling |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Henry Lik Yuen |e verfasserin |4 aut | |
| 700 | 1 | |a Kong, Alice Pik-Shan |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Wah Kheong |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Vincent Wai-Sun |e verfasserin |4 aut | |
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