Randomised controlled trial of structured personal care of type 2 diabetes mellitus

Abstract

Objective To assess the effect of a multifaceted intervention directed at general practitioners on six year mortality, morbidity, and risk factors of patients with newly diagnosed type 2 diabetes.Design Pragmatic, open, controlled trial with randomisation of practices to structured personal care or routine care; analysis after 6 years. Setting 311 Danish practices with 474 general practitioners (243 in intervention group and 231 in comparison group). Participants 874 (90.1%) of 970 patients aged >40 years who had diabetes diagnosed in 1989-91 and survived until six year follow up. Intervention Regular follow up and individualised goal setting supported by prompting of doctors, clinical guidelines, feedback, and continuing medical education. Main outcome measures Predefined clinical non-fatal outcomes, overall mortality, risk factors, and weight. Results Predefined non-fatal outcomes and mortality were the same in both groups. The following risk factor levels were lower for intervention patients than for comparison patients (median values): fasting plasma glucose concentration (7.9 v 8.7 mmol/l, P = 0.0007), glycated haemoglobin (8.5% v 9.0%, P < 0.0001; reference range 5.4-7.4%), systolic blood pressure (145 v 150 mm Hg, P = 0.0004), and cholesterol concentration (6.0 v 6

The Impact of Planned Care and a Diabetes Electronic Management System on Community-Based Diabetes Care

“…Planned care, as originally advocated by Wagner et al (1), involves redesigning the health care delivery system to support patient self-management by using clinical information and decision support systems (10). Consistent with others, we found that implementation of planned care in a primary care setting was associated with improved performance measures (11)(12)(13)(14) and improved metabolic outcomes (13). Few models of care, including planned care, can consistently improve performance measures when more than five preventive measures (as with diabetes) are targeted (12).…”

“…For instance, a 10% increase in immunizations (similar to the change from 64 to 80% associated with DEMS use in this study) could mean, in a population of 1,000 patients with diabetes followed for 1 year, two fewer deaths and one fewer hospitalization due to pneumonia (15). The expanded role of the diabetes nurse educator in this project provides an example of the role played by members of the health care team in quality improvement activities (3,(11)(12)(13). All members of the team actively participated in the adoption of guidelines and assisted in the planning of multifaceted interventions.…”

“…Unfortunately, many "final" reports of health services evaluations lack power to demonstrate improvements in patient outcomes. Largely, this is due to funding limitations and changes in funding priority (13). Our study was large enough to detect the incremental impact of DEMS over that of planned care on performance measures.…”

Bruk av skjema i oppfølgingen av diabetes i allmennpraksis

“…Vi inkluderte syv randomiserte, kontrollerte studier publisert mellom 2001 og 2011 (tab 1) (13 -19 (19). Antall pasienter varierte fra 335 til 7 412, og gjennomsnittsalderen var rundt 60 år.…”

Randomised controlled trial of intensive multifactorial treatment for cardiovascular risk in patients with screen-detected type 2 diabetes: 1-year data from the ADDITION Netherlands study

“…24 This study included clinically diagnosed patients with type 2 diabetes. GPs were assigned to routine care or structured care.…”