Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Sonnaville, J.J.J. de; Bouma, Margriet; Colly, L. P.; Devillé, W.L.J.M.; Wijkel, D.; Heine, Robert J.

doi:10.1007/s001250050829

Cited by 109 publications

(69 citation statements)

References 23 publications

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“…In 14 (20,21,23,28,29,31,39,44,(51)(52)(53)58,59,64) of these, the guidelines were locally developed, in 11 studies (22,24,26,27,32,35,36,47,55,57,60) they were based on national guidelines, and in 2 studies (46,54) the source of the guidelines was not specified.…”

Section: Discussionmentioning

confidence: 99%

“…In 18 studies (21,(27)(28)(29)33,34,36,37,40,41,47,51,52,56,60,61,63,66), the outcomes were all reliably assessed (outcomes obtained from an automated system or a reported agreement between two raters Ͼ90% or Ն 0.8). Furthermore, 15 studies (20,22,26,32,35,39,44,46,50,53,54,57,59,62,64) included objective laboratory assessment of glycemic control.…”

Section: Study Qualitymentioning

confidence: 99%

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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OBJECTIVE -To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS-A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used.RESULTS -A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care.CONCLUSIONS -Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care. Diabetes Care 24:1821-1833, 2001D iabetes is a major and growing health care problem. Primarily because of the increasing prevalence of type 2 diabetes as well as the increase in cases of type 1 diabetes (1), it is expected that the number of people with diabetes will double by the year 2010 (2).Diabetes accounts for a huge burden of morbidity and mortality through micro-and macrovascular complications (3,4). However, it is now clear that strict control of blood glucose, blood pressure, and cholesterol can reduce the risk of diabetes-related complications (5-8). To achieve strict control, structured care is needed (9).Over the past 20 years, the responsibility for the care of people with diabetes has shifted away from hospitals to primary care (10,11). During this period, randomized trials have demonstrated that if regular review of patients is guaranteed, the standard of primary care can be as good or better than hospital outpatient care in the short term (9). Several guidelines and diabetes management programs have been developed nationally and locally to improve diabetes care in the community. However, empirical data suggest that compliance with diabetes clinical practice recommendations is inadequate in primary care (12)(13)(14...

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Section: Discussionmentioning

confidence: 99%

Section: Study Qualitymentioning

confidence: 99%

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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“…Serum samples were obtained from 785 patients (age 64.3 ± 12.3, median 65.5, range 40.0±96.0 years) with Type II diabetes participating in a regional shared care project in Amsterdam [19]. The duration of diabetes was 0±44.9 years [mean 4.3 ± 5.0, median 1.9 years; 231 patients with recently diagnosed diabetes ( < 3 months)].…”

Section: Methodsmentioning

confidence: 99%

Immunological heterogeneity in Type I diabetes: presence of distinct autoantibody patterns in patients with acute onset and slowly progressive disease

et al. 1998

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“…Thus, the results of this study suggest that equipping individuals with diabetes at highest risk for foot ulceration with simple skin temperature devices may significantly reduce the risk for foot ulcers. In fact, just as with comprehensive general programs aimed to facilitate good glucose control (40), a regimen incorporating home temperature monitoring may allow individuals to monitor their "dose" of activity by checking their skin temperatures just as they might monitor their dose of insulin by checking their glucose. It seems likely that the cost benefit of home temperature monitoring might be much better than that for using glucose strips for home monitoring.…”

Section: Preventing Diabetic Foot Ulcer Recurrencementioning

confidence: 99%

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients

Lavery

Higgins²,

Lanctot³

et al. 2007

Diabetes Care

369

402

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OBJECTIVE -The purpose of this study was to evaluate the effectiveness of a temperature monitoring instrument to reduce the incidence of foot ulcers in individuals with diabetes who have a high risk for lower extremity complications.RESEARCH DESIGN AND METHODS -In this physician-blinded, randomized, 15-month, multicenter trial, 173 subjects with a previous history of diabetic foot ulceration were assigned to standard therapy, structured foot examination, or enhanced therapy groups. Each group received therapeutic footwear, diabetic foot education, and regular foot care. Subjects in the structured foot examination group performed a structured foot inspection daily and recorded their findings in a logbook. If standard therapy or structured foot examinations identified any foot abnormalities, subjects were instructed to contact the study nurse immediately. Subjects in the enhanced therapy group used an infrared skin thermometer to measure temperatures on six foot sites each day. Temperature differences Ͼ4°F (Ͼ2.2°C) between left and right corresponding sites triggered patients to contact the study nurse and reduce activity until temperatures normalized.RESULTS -The enhanced therapy group had fewer foot ulcers than the standard therapy and structured foot examination groups (enhanced therapy 8.5 vs. standard therapy 29.3%, P ϭ 0.0046 and enhanced therapy vs. structured foot examination 30.4%, P ϭ 0.0029). Patients in the standard therapy and structured foot examination groups were 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group.CONCLUSIONS -Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations.

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Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Cited by 109 publications

References 23 publications

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Immunological heterogeneity in Type I diabetes: presence of distinct autoantibody patterns in patients with acute onset and slowly progressive disease

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients

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