title: Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR).
abstract: OBJECTIVE
  To evaluate the effect of system interventions (formalized data collection and 100% coverage of medications and supplies) combined with physician and/or patient education on therapeutic indicators and costs in Type 2 diabetes.
  
  
  METHODS
  This was a randomized 2 × 2 design in public health, social security or private prepaid primary care clinics in Corrientes, Argentina. Thirty-six general practitioners and 468 adults with Type 2 diabetes participated. Patients of nine participating physicians were selected randomly and assigned to one of four structured group education programmes (117 patients each): control (group 1), physician education (group 2), patient education (group 3), and both physician education and patient education (group 4), with identical system interventions in all four groups. Outcome measures included HbA(1c), BMI, blood pressure, fasting glucose, lipid profile, drug consumption, resource use and patient well-being at baseline and every 6 months up to 42 months.
  
  
  RESULTS
  HbA(1c) decreased significantly from 4 mmol/mol to 10 mmol/mol by 42 months (P < 0.05); the largest and more consistent decrease was in the groups where patients and physicians were educated. Blood pressure and triglycerides decreased significantly in all groups; the largest changes were recorded in the combined education group. The World Health Organization-5 Lowe score showed significant improvements, without differences among groups. The lowest treatment cost was seen in the combined education group.
  
  
  CONCLUSIONS
  In a primary care setting, educational interventions combined with comprehensive care coverage resulted in long-term improvement in clinical, metabolic and psychological outcomes at the best cost-effectiveness ratio.
authors.affiliation: CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS), Facultad de Ciencias Médicas UNLP, La Plata, Argentina. direccion@cenexa.org
authors.forename: J J
authors.initials: JJ
authors.lastname: Gagliardino
authors.forename: S
authors.initials: S
authors.lastname: Lapertosa
authors.forename: G
authors.initials: G
authors.lastname: Pfirter
authors.forename: M
authors.initials: M
authors.lastname: Villagra
authors.forename: J E
authors.initials: JE
authors.lastname: Caporale
authors.forename: C D
authors.initials: CD
authors.lastname: Gonzalez
authors.forename: J
authors.initials: J
authors.lastname: Elgart
authors.forename: L
authors.initials: L
authors.lastname: González
authors.forename: C
authors.initials: C
authors.lastname: Cernadas
authors.forename: E
authors.initials: E
authors.lastname: Rucci
authors.forename: C
authors.initials: C
authors.lastname: Clark
mesh_terms: D000368:Aged; D001118:Argentina; D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000191:economics / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners / Q000193:education; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D006949:Hyperlipidemias / Q000150:complications / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D010353:Patient Education as Topic / Q000191:economics; D011320:Primary Health Care / Q000191:economics
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human