Effects of protocol-driven care versus usual outpatient clinic care on survival rates in patients with type 2 diabetes.
OBJECTIVE
To determine whether clinical outcomes in patients with type 2 diabetes were improved by protocol-driven care in a Diabetes Centre compared with usual outpatient care.


METHODS
Descriptive analysis of a prospective cohort.


METHODS
During a median 7-year observational period, 91 patients with type 2 diabetes and no cardiovascular or renal complications were monitored by a nurse and a diabetologist in a clinical trial setting according to a structured protocol. Another 81 patients with comparable clinical characteristics were monitored by generalists at the medical clinic in the same hospital. Clinical end points, defined as death and cardiovascular and renal events, were evaluated in 1997 by review of case records.


RESULTS
Patients receiving structured care had lower mortality (relative risk [RR] = 0.21; 95% confidence interval [CI] = 0.07, 0.65; P = .006) than the usual-care group, as well as a lower incidence of combined clinical end points (RR = 0.43; 95% CI = 0.22, 0.84; P = .01). In the usual-care group, patients who had no monitoring of glycosylated hemoglobin or plasma lipid levels during the entire observational period (8.6%) had a 14.6-fold (P < .01) and 15.7-fold (P < .01) increased risk of death and combined clinical end points, respectively, compared with those who had at least one measurement (60.5%).


CONCLUSIONS
Management by protocol-driven care model improved survival and clinical outcomes in patients with type 2 diabetes. Definitive studies are required to confirm these findings and compare the cost effectiveness of these care models.
So
Wing Yee
WY
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, 30-32 Ngan Shing Street Shatin, NT, Hong Kong. wingyeeso@cuhk.edu.hk
Tong
Peter C Y
PC
Ko
Gary T C
GT
Leung
Wilson Y S
WY
Chow
Chun-Chung
CC
Yeung
Vincent T F
VT
Chan
Wing-Bun
WB
Critchley
Julian A J H
JA
Cockram
Clive S
CS
Chan
Juliana C N
JC
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D002985:Clinical Protocols; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D019468:Disease Management; D016903:Drug Monitoring; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D016019:Survival Analysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004656:Enalapril; D006442:Glycated Hemoglobin; D009543:Nifedipine