Research: Many programs to help diabetics manage their health do work
A new study has found that programs aimed at helping people prevent or manage diabetes are most successful if they are directed at the patient or the health care system. Programs aimed at physicians were only successful for patients with poorer diabetes control.
Such interventions also work best for diabetics in poorer health than those who are managing their illness well, the study found.
The study--a comprehensive review of 142 clinical trials involving more than 123,000 patients by Dr. Andrea Tricco, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, appears in The Lancet.
Dr. Tricco said that despite evidence showing improved clinical outcomes for diabetics who received various preventive and therapeutic interventions, many patients do not receive them.
"The gap between ideal and actual care is not surprising in view of the complex nature of diabetes management, often needing coordinated services of primary care physicians, allied health practitioners and subspecialists," she said. "Moreover, it is a challenge to change patient behavior and encourage healthy lifestyles."
She said that with the increasing prevalence of diabetes and the burgeoning cost of managing patients with this disease, improving the efficiency of diabetes care is an important goal.
According to the Canadian Diabetes Association, more than nine million Canadians have diabetes or prediabetes. By 2020, it's estimated that diabetes will cost the Canadian healthcare system $16.9 billion a year.
"Although clinicians, managers and policy makers expend significant time and resources attempting to optimize care for patients with diabetes, the optimum approach to improving diabetes care and outcomes remains uncertain," Dr. Tricco said.
Her review of clinical trials found:
- For patients with high levels of HbA1c the average blood sugar level over three months strategies that target the health care system are quite effective, especially team changes and case management. High levels of HbA1c indicate patients are in poorer health than those with low levels. Team changes programs are those that add another health care worker to a patient's team, such as an endocrinologist or nutritionist. Case management programs require someone other than the primary physician, such as a nurse, to coordinate care in a clinic. The review found these strategies had a positive impact on cardiovascular risk factors such as LDL cholesterol and blood pressure after 12 months
- Strategies that target patients are effective regardless of their HbA1c levels
- Strategies aimed at physicians are not as effective, especially not for people who are already controlling their diabetes well
Overall, the use of quality improvement strategiesclinical reminders, clinical education. patient behavior, patient education-- resulted in a 0.37 per cent reduction of HbA1c after an average follow-up of one year. The meta-analysis did not find a statistically significant improvement in the use of statins (drugs that reduce cholesterol), hypertension reduction or smoking cessation. The interventions did play an important role in increasing the use of aspirin and antihypertensive medication over a median follow-up of 13 months. They also were associated with an increase in retinopathy (inflammation of the eye), screening, screening for renal disease and foot screening over a median follow-up of 12 months.
Dr. Tricco said wide implementation of such strategies could have important benefits, as research has shown that a 1 per cent reduction in mean HbA1c results in 21 per cent fewer deaths, 14 per cent fewer myocardial infarctions and a 37 per cent decrease in microvascular complications.
"Further research is needed to identify which interventions and combinations of QI strategies will optimally improve important outcomes in patients with diabetes at an acceptable cost to aid health-system planning."
Journal reference: The Lancet
Provided by St. Michael's Hospital
- Doubts over long term impact of group education for diabetes patients Apr 26, 2012 | not rated yet | 0
- Dietary advice improves blood sugar control for recently diagnosed type 2 diabetes patients Jun 28, 2011 | not rated yet | 0
- Disease-management programs shown to improve diabetes care Dec 13, 2010 | not rated yet | 0
- Electronic health records could improve care for type 2 diabetics Jan 25, 2012 | not rated yet | 0
- Intensive glucose control in diabetics reduces heart attacks May 26, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Calculating Steam Pressure in Closed Container
1 hour ago I am trying to calculate the volume of liquid water i need to place in a sealed container in order to obtain 10 psi of steam pressure in that closed...
Learning curve of Electromagnetism?
7 hours ago I'm taking a first year physics course and have been having a little trouble with the basics of newtons laws and forces and whatnot, though nothing...
thin glass in liquid
7 hours ago I have one question about optics because I start interested in it. If an object is placed a distance p from a thin glass lens (index of refraction...
How many joules expended for a push up?
10 hours ago Just wondering if any of you can do the calculation that well approximates the amount of joules expended by a push up.
force to keep the folding doors
10 hours ago Hello, I would like to ask you to calculate the force F, which needed to keep the folding doors in this position. I would like to know what is the...
Confusion regarding direction of kinetic friction on inclined plane.
11 hours ago *please help! * The formula for kinetic friction acting on a sliding body is μkN When the body is sliding with constant velocity down an...
- More from Physics Forums - Classical Physics
More news stories
(HealthDay)—Moderate aerobic exercise prevents fructose-induced hypertriglyceridemia in healthy males, according to a study published online May 14 in Diabetes.
Diabetes May 17, 2013 | 5 / 5 (1) | 0 |
A DNA variant near a digestive enzyme does not only affect risk of developing diabetes but also affects the response to treatment, an international consortium of researchers including the University of Dundee has found.
Diabetes May 17, 2013 | not rated yet | 0 |
(Medical Xpress)—Development of a sophisticated artificial pancreas holds potential to transform the lives of patients with Type 1 diabetes.
Diabetes May 16, 2013 | 5 / 5 (1) | 0 |
A small University at Buffalo study has found for the first time that in Type 1 diabetics, insulin injections exert a strong anti-inflammatory effect at the cellular and molecular level, while even small amounts of glucose ...
Diabetes May 16, 2013 | not rated yet | 0
(HealthDay)—Home diabetes regimens partially explain the increased risk of having a hypoglycemia event during hospitalization among older African-American men with diabetes, according to a study published ...
Diabetes May 14, 2013 | not rated yet | 0
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
10 hours ago | not rated yet | 0 |
The latest makeover to a massive psychiatric tome honored by some, reviled by others and even called the "Bible" of mental disorders is being released Saturday with a host of new changes.
8 hours ago | not rated yet | 0
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
8 hours ago | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
19 hours ago | 5 / 5 (1) | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
20 hours ago | 5 / 5 (1) | 0 |
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
10 hours ago | 5 / 5 (2) | 0