title: Effectiveness of the Austrian disease management programme "Therapie Aktiv" for type 2 diabetes regarding the improvement of metabolic control, risk profile and guideline adherence: 2 years of follow up.
abstract: BACKGROUND
  We evaluated the disease management programme (DMP) "Therapie Aktiv" for diabetes mellitus type 2 during the first year of implementation in a cluster-randomised controlled trial (RCT), which revealed an improvement of process quality, but only insignificant effects on HbA1c. To further analyse the effects of the DMP we followed up participants of the RCT for another year.
  
  
  METHODS
  After completion of the RCT, the study was continued as an open observational trial. By patient's choice, three groups were formed. Group 1 (DMP/DMP): interventions of the RCT (DMP), who remained in the DMP; group 2 (Control/DMP): controls of the RCT (usual care), who participated in the DMP during the second year; group 3 (Control/Control): controls of the RCT (usual care), who remained as controls.
  
  
  METHODS
  HbA1c.
  
  
  METHODS
  BMI, lipids, blood pressure and measures of process quality.
  
  
  RESULTS
  Only 801 of 1,489 RCT participants completed the study (53.8 %). Group 1: n = 355; group 2: n = 335; group 3: n = 111. After 2 years, pre-post-analysis revealed a significant reduction of HbA1c (0.37 %, p < 0.001) in both DMP groups, and a reduction of only 0.03 % (p = 0.975) in the control group. However, the difference between the groups was not significant (p = 0.065). There was a significant improvement of process quality in the DMP groups compared with controls.
  
  
  CONCLUSIONS
  The DMP clearly enhances process quality. Furthermore, the DMP yields a reduction of HbA1c within groups after 2 years, but significance is lost in between-group analysis. We conclude that the DMP has only a minor effect on metabolic control.
authors.affiliation: Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria. maria.flamm@pmu.ac.at
authors.forename: Maria
authors.initials: M
authors.lastname: Flamm
authors.forename: Sigrid
authors.initials: S
authors.lastname: Panisch
authors.forename: Henrike
authors.initials: H
authors.lastname: Winkler
authors.forename: Tim
authors.initials: T
authors.lastname: Johansson
authors.forename: Raimund
authors.initials: R
authors.lastname: Weitgasser
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Sönnichsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015397:Program Evaluation; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human