Less frequently reported were quality of life , patient satisfaction , self-care , and healthcare utilization .
Most care management modalities were carved out from primary care .
Conclusions Most care management programs for patients with type 2 diabetes are ' carved-out ' , accomplish limited effects on metabolic outcomes , and have unknown effects on patient important outcomes .
Background This systematic review and meta- analysis aims at assessing the composition and performance of care management models evaluated in the last decade and their impact on patient important outcomes .
Evaluation of a diabetes specialist–guided primary care diabetes treatment program
Purpose An initial pilot program demonstrated promising results in improvements in glycosylated hemoglobin ( HbA1c ) , low-density lipoprotein cholesterol ( LDL-C ) , and systolic blood pressure ( SBP ) and prompted us to test these findings in a controlled trial . The purpose of the Diabetes-focused , Algorithm-directed care , Midlevel practitioner – administered , Electronically coached , Treatment ( DAMET-2 ) program clinical trial was to investigate the benefits of a novel program for disseminating guidance in the treatment of diabetes from a central specialist clinic to primary care centers with access to midlevel provider services . Data sources DAMET-2 included st and ardized treatment algorithms and education disseminated through computer-assisted and traditional methods associated with distance medicine . Two primary care practice s were selected and subjects with diagnosed type 2 diabetes ≥6 months , ≥18 years of age with one or more cardiovascular risk factors ( identified by chart review ) were eligible for inclusion . Midlevel practitioners for subjects in the experimental group ( N= 34 ) received training in American Diabetes Association treatment algorithms , had telephone consultations at 2- to 4-week intervals and bimonthly visits with diabetes specialists , and received treatment guidance within 24 h from remote diabetes specialists . Weekly diabetes clinics were made available to subjects in the experimental group . After 12 months , the last available subject data were extracted from the subjects ' charts and compared to 12-month chart data from a control group ( N= 101 ) that did not receive additional study services . Conclusions Mean HbA1c values decreased from baseline by 0.46 % in the active treatment group versus 0.06 % in the control group ; however , reductions in HbA1c did not achieve statistical significance potentially because of the small sample size of the experimental group . Mean SBP values were significantly reduced in both groups ; however , LDL-C was only significantly reduced in the control group , where more aggressive use of statins may have had an effect . Implication s for practice Despite the inconsistencies in risk factor reduction from the pilot program , the DAMET-2 program provided insights regarding the importance of electronic records and provider notifications , patient adherence , prioritization of provider re sources by risk factor level among patients , and access to self-management education
Less frequently reported were quality of life , patient satisfaction , self-care , and healthcare utilization .
Most care management modalities were carved out from primary care .
Conclusions Most care management programs for patients with type 2 diabetes are ' carved-out ' , accomplish limited effects on metabolic outcomes , and have unknown effects on patient important outcomes .
Background This systematic review and meta- analysis aims at assessing the composition and performance of care management models evaluated in the last decade and their impact on patient important outcomes .