Disease-management programs moderately improve diabetes care
MedWire News: Results from a systematic review and meta-analysis show that participation in disease-management programs leads to moderately improved levels of glycated hemoglobin (HbA1c) in adults with diabetes.
Clément Pimouguet (Université Victor Segalen, Bordeaux Cedex, France) and colleagues reviewed 41 randomized controlled trials that reported pre- and postintervention HbA1c, and lasted for at least 12 weeks. The studies were all published between 1990 and 2009 and included a total of 7013 adults with Type 1 or Type 2 diabetes.
Disease-management programs have varying definitions, but in this case were defined as ongoing and proactive follow-up of patients including at least two from: patient education, coaching to overcome psychological or social barriers impeding effective treatment, treatment adjustment, patient monitoring, and care coordination between the patient, disease manager, and primary care physician.
Writing in the Canadian Medical Association Journal, Pimouguet and team report that participation in disease-management programs led to a significantly greater mean reduction in HbA1c, compared with normal care, of 0.38%.
They found that programs in which the disease manager was allowed to start or modify treatment without prior approval from the primary care physician resulted in significantly greater reductions in HbA1c compared with programs that had no such approval, at 0.60% versus 0.28%.
Programs with a high frequency of contact with patients also resulted in a significantly larger decrease in patients' HbA1c than those with low levels of patient contact, at 0.56% versus 0.30%.
"More research is needed concerning the long-term impact of disease-management programs on glycemic control, microvascular and macrovascular complications, admission to hospital, and mortality," write the authors.
"Further research should also determine whether, in addition to patients with nonstabilized diabetes, other groups of patients with diabetes would benefit from disease management," they say.
"Lastly, high-quality cost-effectiveness studies of disease-management programs are needed to direct care providers and policy-makers in the allocation of healthcare resources."
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By Helen Albert