Changes in long-term glycemic control and performance indicators in a cohort of type 2 diabetic patients cared for by general practitioners: findings from the "Modena Diabetes Project".
OBJECTIVE
General practitioners (GPs) are being increasingly asked to play a key role in the shared care of people with diabetes mellitus, but data concerning the effects of this in Italy are still scarce. We therefore evaluated the 4-year follow-up changes in outcomes and performance indicators in type 2 diabetic patients cared for by GPs in the framework of the "Modena Diabetes Project".


RESULTS
Seventy-four percent of the local GPs participating in the project (387 out of 521) sent 5260 paired baseline and follow-up datasheets. The baseline characteristics of the type 2 diabetic patients (49.6% male) were a mean age of 67.3+/-11.2 years, a mean disease duration of 10.9+/-7.4 years, a mean BMI of 28.7+/-4.8 kg/m2, and a mean HbA1c level 7.56+/-1.52%. After four years follow-up, the individual before/after match-paired outcomes revealed an improvement in glycemic control: HbA1c levels significantly decreased to 7.39+/-1.31%, and the percentage of patients with HbA1c level of <6.5% significantly increased from 15.7% to 22.1%. There was also a significant decrease in body weight (from 78.3+/-14.8 to 77.6+/-14.6 kg) and BMI (from 28.8+/-4.8 to 28.5+/-4.9 kg/m2). The time trends of glycemic control significantly improved during the 4-year follow up, but those of the body weight and BMI values did not. Furthermore, the percentages of performance indicators matching the expected rate of recurrence per each year of follow-up significantly improved during the study period.


CONCLUSIONS
Long-term glycemic control and the performance indicators relating to the type 2 diabetic patients participating in our shared care programme progressively improved.
Centre for the Evaluation of the Effectiveness of Health Care, CeVEAS, Azienda USL, Modena, Italy. a.ciardullo@ausl.mo.it
A V
AV
Ciardullo
M M
MM
Daghio
M
M
Brunetti
M
M
Bevini
G
G
Daya
G
G
Feltri
D
D
Novi
C A
CA
Goldoni
A
A
Messori
A
A
Guerzoni
N
N
Magrini
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control*; D005194:Family Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007558:Italy; D008297:Male; D016555:Matched-Pair Analysis; D009765:Obesity; D010821:Physicians, Family; D015431:Weight Loss
D001786:Blood Glucose; D006442:Glycated Hemoglobin