Evaluation of a Structured Teaching and Treatment Programme for Type 2 Diabetes in General Practice in a Rural Area of Austria

Abstract

The efficacy of a treatment and teaching programme for non-insulin-treated Type 2 diabetic patients in general practice was evaluated in a prospective, controlled study. In a rural area in southern Austria, 53 patients from seven general practices participated in a structured programme (intervention group) and 55 patients from seven general practices without the programme served as the control group. After 6 months the weight reduction in the intervention group was 2.6 kg (1.6-3.7 kg, p < 0.001) and the difference in HbA1c between the groups was 0.92% (0.23-1.61%, p < 0.01) at follow-up. Systolic (-16.6 mmHg) and diastolic (-11.1 mmHg) blood pressure, serum triglycerides (-0.63 mmol I-1), and serum cholesterol (-0.40 mmol I-1) were reduced significantly in the intervention group (p < 0.006). The number of patients with callus formation and poor nail care decreased significantly after participating in the teaching programme (p < 0.001). In the control group no reduction in body weight, metabolic control or in risk factors for diabetic foot complications were observed. Calculated health care costs per patient and year decreased in the intervention group (-33 pounds) and increased in the control group (+ 30 pounds) mainly due to changes in prescription of oral hypoglycaemic agents in both groups. This programme may be an efficient and helpful model to increase overall quality of diabetes care according to the St Vincent Declaration.

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

“…Following the selection criteria of the reviews, 16 publications [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] referring to our three reference programmes should have been identified. In practice, a total of 11 were identified [5,28,30,32,34,38,39,[43][44][45][46], and seven [28,32,34,35,38,39,46] were included in at least one of the reviews. In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25].…”

“…In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25]. Out of 25 [5, 33-37, 39, 41-43, 45-59] replication trials (phase 4, see text box: Phases of 'increasing evidence of complex interventions') four [34,35,39,46] were included in six reviews [16,19,21,22,24,25]. Different reviews on identical topics included different publications referring to the same reference programme.…”

“…Nine reviews included qualitative data synthesis within categories [13,[19][20][21][22][24][25][26][27] (Table 1). In some reviews [10,11,18] the allocation into categories did not meet the type of intervention [32,34,35].…”

Patient education - evaluation of a complex intervention

“…The impossibility to clearly separate interventions according to these criteria is reflected by the handling of three publications on an identical intervention that is the group treatment and teaching programme for patients with Type II diabetes as described in the present article. The review included the publication by Pieber et al [47], but not those by Kronsbein et al [46] and Domenech et al [48]. All three studies had a similar study design.…”

“…The effectiveness of the programme was replicated in a rural area of Austria in a controlled trial with 6-months follow-up [47]. Comparable outcomes of reduction of body weight and use of sulfonylurea were observed.…”