Structured primary care for type 2 diabetes has positive effects on clinical outcomes.
BACKGROUND
Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved.


OBJECTIVE
The aim of the study was to evaluate the effects of structured diabetes care on clinical outcomes of patients with type 2 diabetes in primary care.


METHODS
We performed a quasi-experimental study on the effects of structured care consisting of organizational and educational components (n = 581) compared with care-as-usual (n = 152). We assessed clinical outcomes of HbA1c, blood pressure, cholesterol, creatinine and body mass index, at baseline and after 1 year. The long-term effects in the structured care group were determined after another 2 years.


RESULTS
Structured care led to improvement in HbA1c and long-term improvements in blood pressure and cholesterol compared with care-as-usual. After 1 year, the percentage of patients who did not deteriorate was higher in the structured care group, again for HbA1c, diastolic blood pressure, low-density lipoprotein cholesterol and body mass index.


CONCLUSIONS
Structured diabetes care consisting of multiple components has a positive effect on clinical outcomes compared with care-as-usual. Our findings support its further implementation in order to reduce complications in type 2 diabetes patients.
Fokkens
Andrea S
AS
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.s.fokkens@med.umcg.nl
Wiegersma
P Auke
PA
Beltman
Frank W
FW
Reijneveld
Sijmen A
SA
D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007318:Inservice Training; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D012307:Risk Factors
D003404:Creatinine; D006442:Glycated Hemoglobin; D008055:Lipids