Family Medicine

ICM-driven nurse-managed diuretic protocol was safe but not efficacious for 60-day HF outcomes.

In ALLEVIATE-HF (n=711) an ICM risk-detection system plus centrally coordinated nurse-facilitated diuretic protocols did not improve the prespecified 60-day, five-component hierarchical composite (win ratio 0.79; 95% CI 0.62–1.01; P=0.06). Serious adverse events related to the intervention were rare at 0.32%, meeting the prespecified safety threshold. Cumulative cardiovascular death and HF events were numerically higher in the intervention arm (HR 1.43; 95% CI 0.95–2.15; P=0.091), a signal needing cautious interpretation. Exploratory adjustment for baseline imbalance neutralized the primary result, so this implementation strategy is not clearly effective. 1

Village doctor–led integrated care increased glucose monitoring and improved fasting glucose trends.

In this cluster-randomized pilot (n=215), integrated care with telemedicine and incentives raised daily glucose monitoring adherence to 87.6% versus 76.5% in usual care. HbA1c fell more in the integrated arm (−0.42% vs −0.23%) over 3 months, but the between-group difference was not statistically significant. Fasting glucose showed a significant downward trend across 13 weeks (β = −0.077; P<0.001), driven more by the integrated arm. This model appears feasible in rural primary care but requires larger trials to confirm durable HbA1c benefits. 2

CHW-led, tablet-assisted diabetes care modestly improved 12-month HbA1c and engagement.

In rural Lesotho (primary analysis n=103), CHWs using tablet decision support achieved mean HbA1c 6.5% at 12 months versus 7.1% with facility referral (adjusted mean difference −0.46%, 95% CI −1.14 to 0.22). Engagement in care was higher in the CHW-led arm, with no important safety differences reported. Effect estimates were modest and CIs include the possibility of no benefit, so larger studies should confirm effectiveness and scalability. 3