The effect on patient outcomes remained less clear as these were rarely assessed .
Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes .
Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes .
REVIEW ER 'S CONCLUSIONS Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .
Organisational interventions that improve regular prompted recall and review of patients ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management .
The addition of patient-oriented interventions can lead to improved patient health outcomes .
BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care .
Different systems have been proposed to manage diabetes care .
Complications in IDDM are caused by elevated blood glucose level: The Stockholm Diabetes Intervention Study (SDIS) at 10-year follow up
Summary Blood glucose values close to normal reduce the microvascular complications of insulin-dependent diabetes mellitus . The Stockholm study of this effect continued after the initial 7.5-year period in order to see what happened when intensively treated patients were left to control their own treatment while treatment was intensified in the control group . Forty-three patients with insulin-dependent diabetes r and omised to intensified conventional treatment ( ICT ) and 48 patients r and omised to st and ard treatment ( ST )  were followed-up for 10 years . Vascular complications , treatment side-effects and well-being were studied . Risk factors for complications were sought . HbA1c ( normal range 3.9–5.7 % ) was reduced from 9.5 ± 1.4 % ( mean ± SD ) in the ICT group and 9.4 ± 1.2 % in the ST group to a mean ( during 10 years ) of 7.2 ± 0.6 % and 8.3 ± 1.0 % , respectively ( p < 0.001 ) . Serious retinopathy ( 63 vs 33 % , p = 0.003 ) , nephropathy ( 26 vs 7 % , p = 0.012 ) and symptoms of neuropathy ( 32 vs 14 % , p = 0.041 ) were more common in the ST group after 10 years . HbA1c and age were the only risk factors for complications . Self-reported well-being increased to a greater degree and severe hypoglycaemia was more common in the ICT group . Cognitive function after 10 years was similar in both treatment groups , and was not related to the number of severe hypoglycaemic episodes . Intensified insulin treatment leads to reduced long-term complications and increased well-being without causing undue side-effects . [ Diabetologia ( 1996 ) 39 : 1483–1488
The effect on patient outcomes remained less clear as these were rarely assessed .
Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes .
Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes .
REVIEW ER 'S CONCLUSIONS Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .
Organisational interventions that improve regular prompted recall and review of patients ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management .
The addition of patient-oriented interventions can lead to improved patient health outcomes .
BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care .
Different systems have been proposed to manage diabetes care .