Shared and delegated systems are not quick remedies for improving diabetes care: a systematic review.
BACKGROUND
Type 2 diabetes is an important, chronic condition notorious for its costly and disabling complications. Nowadays, enhanced cooperation is expected to improve the quality of diabetes care and reduce risks for chronically ill patients. It is, however, questionable whether this assumption is evidence based.


METHODS
Using a structured literature search, we selected systematic reviews, randomised controlled trials (RCTs) and other effect evaluations regarding the sharing and allocation of diabetes care.


RESULTS
We selected 22 studies to include in this review. The process of care improved in all studies investigating this quality aspect. HbA1c improved in seven reviews and in five other studies. All included reviews and four RCTs were unable to demonstrate a positive effect on blood pressure. Total cholesterol improved in two reviews and five other studies.


CONCLUSIONS
The sharing and allocation of diabetes care leads to significant reduction in HbA1c and improves the process of care. However, this improvement has not as yet led to better cardiovascular risk management. For a number of reasons, a truly accurate estimation of the results of shared and allocated diabetes care within the Dutch diabetes care system is not possible.
van Bruggen
J A R
JA
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. j.a.r.vanbruggen@umcutrecht.nl
Gorter
K J
KJ
Stolk
R P
RP
Rutten
G E H M
GE
D019033:Delivery of Health Care, Integrated; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D016032:Randomized Controlled Trials as Topic