Disease-Management Programs Shown to Improve Diabetes Care

Disease-management programs, which may include patient education, psychological intervention, dietary education, self-monitoring, and telemedicine, can improve diabetes care…..

The study, by French researchers, included 41 randomized controlled trials published between 1990 and 2009 with a total of 7,013 patients.

The findings showed that disease-management programs are more effective than usual care in reducing glycated hemoglobin levels in diabetic patients with poor glycemic control.

Moreover, some characteristics of disease-management programs appear to be associated with a greater effectiveness, in particular how often a patient sees a doctor. A high frequency leads to a greater impact on glycated hemoglobin.

“We found that the ability of disease managers to start or modify medical treatment was an effective feature of disease-management programs,” write Dr. Clément Pimouguet, Centre de recherche en épidémiologie et biostatistique, Université Victor Segalen Bordeaux 2, France, and coauthors. “This has important implications, because nonadherence to medical treatment is a significant predictor of all-cause mortality and hospital admission among patients with diabetes.”

The study employed what are known as the ABC’s of diabetes care: A1c blood tests (to check blood sugar), blood pressure control and cholesterol management. An interdisciplinary medical team, led by nurse case managers, included endocrinologists, dieticians, physical therapists and social workers. The team prepared individual care plans for clients and gave podiatry, eye and dental/oral exams.

At each three-month assessment point, at least 60 percent of participants, including those with depression or cognitive impairment, showed a statistically significant decrease in A1c levels, while approximately 25 percent worsened. The analyses demonstrated the program’s general effectiveness in reducing the A1c levels of participants.

The authors conclude that their findings are important for the delivery of diabetes care and the direction of future research. More research is needed, however, to know the long-term impact of disease-management programs and whether other groups besides those with nonstabilized diabetes would benefit from disease management. Also, cost-effectiveness studies of disease-management programs need to be developed to ensure proper allocation of health care resources.   

CMAJ (Canadian Medical Association Journal.