title: A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes.
abstract: OBJECTIVE
  We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes.
  
  
  RESULTS
  Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary end-points were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated. After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p<0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p=0.004) while quality of life changed independently of either (p<0.001). Among controls, quality of life worsened (p<0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p=0.027) and total cholesterol decreased in the controls (p<0.05). HbA1c decreased, though not significantly, in both. Direct costs for group and one-to-one care were Euros 933.19 and Euros 697.10 per patient, respectively, giving a cost-effectiveness ratio of Euros 19.42 spent per point gained in the quality of life scale.
  
  
  CONCLUSIONS
  Group care is applicable and also cost-effective in type 1 diabetes. It improves quality of life, knowledge and behaviours. Future programme adjustments should strive to impact more on metabolic control.
authors.affiliation: Department of Internal Medicine, University of Turin, Corso AM Dogliotti 14, I-10126 Torino, Italy. marina.trento@unito.it
authors.forename: M
authors.initials: M
authors.lastname: Trento
authors.forename: P
authors.initials: P
authors.lastname: Passera
authors.forename: E
authors.initials: E
authors.lastname: Borgo
authors.forename: M
authors.initials: M
authors.lastname: Tomalino
authors.forename: M
authors.initials: M
authors.lastname: Bajardi
authors.forename: A
authors.initials: A
authors.lastname: Brescianini
authors.forename: M
authors.initials: M
authors.lastname: Tomelini
authors.forename: S
authors.initials: S
authors.lastname: Giuliano
authors.forename: F
authors.initials: F
authors.lastname: Cavallo
authors.forename: V
authors.initials: V
authors.lastname: Miselli
authors.forename: P
authors.initials: P
authors.lastname: Bondonio
authors.forename: M
authors.initials: M
authors.lastname: Porta
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life
chemical_list: D006442:Glycated Hemoglobin