[Randomized controlled trial of structured, individualized treatment of type 2 diabetes mellitus. The project of Diabetes Care in General Practice].
BACKGROUND
We assessed the effect of a multifaceted intervention directed at general practitioners to improve type 2 diabetes care.


METHODS
Three hundred and eleven Danish practices with 474 general practitioners were randomised to structured personal care (intervention group) or routine care (comparison group). Of 970 surviving patients (aged 40+ years) diagnosed with diabetes in 1989-1991, 874 (90.1%) were assessed after 6 years. Intervention comprised regular follow-up and individualized goal-setting, supported by reminders to doctors, clinical guidelines, feed-back, and continuing medical education.


RESULTS
Predefined non-fatal outcomes and mortality were the same in both groups. The following risk factor levels were lower in the intervention patients than in the comparison patients: fasting plasma glucose (7.9 vs 8.7 mmol/l, medians, P = 0.0007), haemoglobin A1c (8.5 vs 9.0%, P < 0.0001, normal range 5.4-7.4%), systolic blood pressure (145 vs 150 mmHg, P = 0.0004), and cholesterols (6.0 vs 6.1 mmol/l, P = 0.029, baseline-adjusted). Both groups had sustained a weight loss since diagnosis (2.6 vs 2.0 kg). Metformin was the only drug used more frequently in the intervention group (24 vs 15%). Intervention doctors arranged more follow-up consultations, referred fewer patients to diabetes clinics, and were more optimistic in their goal-setting.


CONCLUSIONS
In primary care, individualized goal-setting with educational and surveillance support may for at least six years bring risk factors of patients with type 2 diabetes to a level that in other trials has been shown to reduce diabetic complications, but without adverse weight gain.
de Fine Olivarius
N
N
Københavns Universitet, Central forskningsenhed for almen praksis, samt Afdeling for Almen Medicin, Biostatistisk Afdeling, Institut for Folkesundhedsvidenskab. no@gpract.ku.dk
Beck-Nielsen
H
H
Andreasen
A H
AH
Hørder
M
M
Pedersen
P A
PA
D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005194:Family Practice; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D016896:Treatment Outcome