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

Jaiveer Saraswathy

James D Lee

John Morrissey

Vinod Patel

Diabetes and Endocrinology Centre, George Eliot Hospital NHS Trust, College Street, Nuneaton, CV10 7DJ, UK, vinod.patel{at}geh.nhs.uk

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.

Key Words: Alphabet strategy • Framingham heart risk. Key words: type 2 diabetes • Steno-2 study • UKPDS

The British Journal of Diabetes & Vascular Disease, Vol. 3, No. 6, 410-413 (2003)
DOI: 10.1177/14746514030030060401


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