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20-06-2010 | Diabetes | Article

CARAT trial to assess chronic care model in Type 2 diabetes


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MedWire News: A study is underway in Europe to assess the feasibility and impact of the “chronic care model” as a framework for managing patients with Type 2 diabetes.

The trial, known as “CARAT” (The Chronic CARe for diAbeTes study), was launched in Switzerland in February 2010 and is employing a cluster randomized design. The trial design and rationale are published in the open-access journal Cardiovascular Diabetology.

“Chronic conditions and multimorbidity represent the major challenge for the health care systems in the industrialized world,” explain Anja Frei (University of Zurich) and fellow CARAT investigators.

“The chronic care model provides a proactive, patient-centred, evidence-based approach to face this challenge.”

Recent studies in a range of chronic diseases have demonstrated that treatment strategies incorporating elements of the chronic care model lead to improved outcomes for both patients and healthcare systems.

To date, however, most of these studies have been performed in the USA, which has a very different healthcare system to that of Europe.

The CARAT trial aims to address this gap by adapting the chronic care model approach to the Swiss healthcare system. A total of 28 general practitioners (GPs) in Switzerland will be randomly assigned to either intervention or control; each GP will enrol 12 patients with Type 2 diabetes.

The intervention will entail the GP and practice nurse working as a team to deliver comprehensive diabetes care tailored to the needs of the individual patient; the control group will receive care as usual.

The primary endpoint is the change in glycated hemoglobin between baseline and 1 year. Secondary endpoints include control of of blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol; quality-of-life; and quality indicators of diabetes care.

“This study challenges the hypothesis that the chronic care model can be easily implemented by a practice-nurse-focused approach,” write Frei et al.

“If our results will confirm this hypothesis, the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Joanna Lyford