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 .
Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial.
OBJECTIVE The objective of this study was to assess the impact of active versus usual monitoring of algorithmic insulin titration and point-of-care ( POC ) versus laboratory HbA1c ( A1C ) measurement on glycemic control in primary care . RESEARCH DESIGN AND METHODS The Glycemic Optimization with Algorithms and Labs at Point of Care ( GOAL A1C ) study was a 24-week , r and omized , parallel-group , four-arm , open-label study of 7,893 adults with type 2 diabetes uncontrolled by oral antidiabetic agents and requiring insulin . Patients were r and omly assigned by investigators from 2,164 sites in the U.S. to insulin glargine with either 1 ) usual ( no unsolicited contact between visits ) insulin titration using a simple algorithm with laboratory A1C testing , 2 ) usual titration with POC A1C testing , 3 ) active ( weekly monitored ) titration with laboratory A1C testing , or 4 ) active titration with POC A1C testing . Outcome measures included a change in A1C and fasting self-monitoring of blood glucose ( SMBG ) levels , percentage of patients achieving A1C < 7.0 % , and hypoglycemia frequency . RESULTS Significant A1C and SMBG reductions were observed in all arms ( P < 0.0001 ) . Compared with usual insulin titration , active titration achieved greater A1C reduction ( 1.5 vs. 1.3 % ; P < 0.0001 ) , SMBG reduction ( 88 vs. 79 mg/dl ; P < 0.0001 ) , and proportion of patients achieving A1C < 7.0 % ( 38 vs. 30 % ; P < 0.0001 ) . Among patients receiving active titration , POC A1C testing was associated with an increase in the proportion achieving an A1C < 7.0 % ( 41 % for POC vs. 36 % for laboratory ; P < 0.0001 ) . Hypoglycemia rates were low ( usual vs. active groups : 3.7 vs. 6.0 all confirmed episodes/patient-year [ P < 0.001 ] ; 0.09 vs. 0.14 severe episodes/patient-year [ NS ] ) . CONCLUSIONS In a predominantly primary care setting , addition of insulin glargine using a simple algorithm achieved significant improvements in glycemic control in patients with type 2 diabetes in all four study arms . Active titration result ed in significant incremental improvements in glycemic control , and , among patients receiving active titration , POC A1C testing result ed in a greater portion achieving A1C < 7.0 %
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 .