Systematic Structured Care Improves Outcome in Diabetics

Dr Juliana C. Chan, of the Chinese University of Hong Kong, and colleagues randomized 204 patients to structured care or to usual care. The structured care group “was managed according to a prespecified protocol with treatment goals including blood pressure <130/80 mmHg and hemoglobin A1c <7%."

At two years, structured care patients had significantly better blood pressure control. After adjustment for factors including age and sex, the proportion of patients who died or reached end-stage renal disease (ESRD) was similar in both groups.

However, 68% of the structured care patients achieved three or more treatment targets compared to 28% of the usual care group. Moreover, patients who reached these goals had a reduced risk of mortality and of ESRD (relative risk, 0.43).

“In most surveys, only 5-10% of people with diabetes have attained multiple treatment goals including those of blood pressure, blood glucose, blood lipids and persistent treatment with renin-angiotensin blockers,” Dr. Chan told Reuters Health.

“Both care providers and patients,” continued Dr. Chan, “must be informed and given support to follow these internationally recommended standards of care to achieve multiple treatment targets to prevent costly and devastating complications.”

Diabetes Care 2009;32:977-982.