Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings

Renders, Carry M.; Valk, Gerlof D.; Griffin, Simon J.; Wagner, Edward H.; Eijk, J.T. van; Assendelft, W. J. J.

doi:10.1002/14651858.cd001481

Cited by 414 publications

(424 citation statements)

References 71 publications

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“…A meta-analysis was performed in eight reviews [9-11, 13, 15, 16, 18-20]. A total of six reviews exclusively used qualitative data synthesis [21][22][23][24][25][26][27] (ESM Table 11). …”

Section: Resultsmentioning

confidence: 99%

“…In eight reviews, experts in the field were contacted to identify additional publications [10,11,13,15,[18][19][20]25]. Reference tracking was performed in 11 reviews [10,11,13,15,16,[18][19][20][21][22]24]. Predefined contact of all authors was not reported in any review.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Six reviews used regression or subgroup analysis to analyse the effect of single active components on outcomes [9,11,13,15,16,19]. Descriptive analysis of the influence of active components was performed in five reviews [19,21,22,24,26]. Most of the components of our three reference programmes had been identified, but only a few had been evaluated.…”

Section: Resultsmentioning

confidence: 99%

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

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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Common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. The aim of the present study was to describe and critically appraise current methods of systematic reviews on complex interventions, using diabetes and hypertension patient education as examples. PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library and Health Technology Assessment databases were searched. Systematic reviews focusing on diabetes or hypertension patient education were included. Authors were contacted. Two investigators independently evaluated the reviews. The available evidence of three patient education programmes of diabetes and hypertension self-management implemented in Germany was used as a reference. We included 14 reviews; 12 reviews mentioned that the included education programmes were multidimensional. Reviews on comparable topics identified different publications of the same programme. Identical programmes were classified differently within and between reviews.Education programmes were dissected to analyse effects of single components. Different components of identical programmes were used. Interdependencies between components were not explored. Six reviews performed metaanalysis across programmes with heterogeneous educational or organisational approaches. The complexity of efficacy measures was disregarded: e.g. HbA 1c was used as an isolated outcome variable without considering treatment goals, effects on hypoglycaemia, body weight or quality of life. Our results indicate that methods of current systematic reviews are not fully equipped to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary.

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“…A meta-analysis was performed in eight reviews [9-11, 13, 15, 16, 18-20]. A total of six reviews exclusively used qualitative data synthesis [21][22][23][24][25][26][27] (ESM Table 11). …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Lenz¹,

Steckelberg²,

Richter

et al. 2007

Diabetologia

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“…The effectiveness of the different interventions carried out by primary care professionals to improve the management of diabetic patients depends on the reduction of the high cardiovascular risk in these patients [10]. We have studied the incidence, prevalence, complications, and cardiovascular risk factors of known Type 2 diabetes in the Basque Country in northern Spain.…”

mentioning

confidence: 99%

Incidence, prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country, Spain

et al. 2003

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Aims/hypothesis. The aim of this study was to determine the incidence, prevalence and coronary heart disease risk in patients with known Type 2 (non-insulindependent) diabetes mellitus in a Basque Country sentinel practice network study. Methods. During the year 2000 we did a survey among sentinel practitioners who registered information about previously and newly diagnosed Type 2 diabetic patients older than 24 years of age. We studied 65,651 people attending a primary care service in the Basque Country Health Service-Osakidetza. We collected information about diabetic complications and cardiovascular risk factors and measured the coronary heart disease risk in these patients. Results. In the year 2000, the standardized cumulative incidence and prevalence of known Type 2 diabetes were 5.0 per 1000 (CI 95%: 4.9-5.1) and 4.6% (CI 95%: 4.5-4.7) respectively. Macroangiopathy was the most frequent complication both in the newly diagnosed (21.6%) and previously known Type 2 diabetic patients (33%). Total cholesterol ≥5.17 mmol/l and LDL cholesterol ≥2.58 mmol/l were found in 75% and 90% of newly diagnosed and 65% and 85% of previously diagnosed Type 2 diabetic patients respectively. Of the Type 2 diabetic patients 42% were obese and 80% had high blood pressure. More than 55% of the men compared with 44% of the women with Type 2 diabetes had high or very high risk of coronary heart disease (p<0.05). Conclusion/interpretation. We report new epidemiological data on known Type 2 diabetes in the Basque Country. These patients have a high frequency of cardiovascular risk factors causing a high coronary heart disease risk. [Diabetologia (2003) 46:899-909]

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An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting

Ziemer¹,

Doyle²,

Barnes³

et al. 2006

Arch Intern Med

106

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Background: Although clinical trials have shown that proper management of diabetes can improve outcomes, and treatment guidelines are widespread, glycated hemoglobin (HbA1c) levels in the United States are rising. Since process measures are improving, poor glycemic control may reflect the failure of health care providers to intensify diabetes therapy when indicated-clinical inertia. We asked whether interventions aimed at health care provider behavior could overcome this barrier and improve glycemic control.Methods: In a 3-year trial, 345 internal medicine residents were randomized to be controls or to receive computerized reminders providing patient-specific recommendations at each visit and/or feedback on performance every 2 weeks. When glucose levels exceeded 150 mg/dL (8.33 mmol/L) during visits of 4038 patients, health care provider behavior was characterized as did nothing, did anything (any intensification of therapy), or did enough (if intensification met recommendations).Results: At baseline, residents did anything for 35% of visits and did enough for 21% of visits when changes in therapy

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Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings

Abstract: Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Review)

Cited by 414 publications

References 71 publications

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

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

Incidence, prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country, Spain

An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting

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