title: Disease management programs for type 2 diabetes in Germany: a systematic literature review evaluating effectiveness.
abstract: BACKGROUND
  Disease management programs (DMPs) are intended to improve the care of persons with chronic diseases. Despite numerous studies there is no unequivocal evidence about the effectiveness of DMPs in Germany.
  
  
  METHODS
  We conducted a systematic literature review in the MEDLINE, EMBASE, Cochrane Library, and CCMed databases. Our analysis included all controlled studies in which patients with type 2 diabetes enrolled in a DMP were compared to type 2 diabetes patients receiving routine care with respect to process, outcome, and economic parameters.
  
  
  RESULTS
  The 9 studies included in the analysis were highly divergent with respect to their characteristics and the process and outcome parameters studied in each. No study had data beyond the year 2008. In 3 publications, the DMP patients had a lower mortality than the control patients (2.3%, 11.3%, and 7.17% versus 4.7%, 14.4%, and 14.72%). In 2 publications, DMP participation was found to be associated with a mean survival time of 1044.94 (± 189.87) days, as against 985.02 (± 264.68) in the control group. No consistent effect was seen with respect to morbidity, quality of life, or economic parameters. 7 publications from 5 studies revealed positive effects on process parameters for DMP participants.
  
  
  CONCLUSIONS
  The observed beneficial trends with respect to mortality and survival time, as well as improvements in process parameters, indicate that DMPs can, in fact, improve the care of patients with diabetes. Further evaluation is needed, because some changes in outcome parameters (an important indicator of the quality of care) may only be observable over a longer period of time.
authors.affiliation: Department of Health Care Management, Technische Universität Berlin, Shared authorship: Fuchs, Henschke and Blümel have equally contributed to the article.
authors.forename: Sabine
authors.initials: S
authors.lastname: Fuchs
authors.forename: Cornelia
authors.initials: C
authors.lastname: Henschke
authors.forename: Miriam
authors.initials: M
authors.lastname: Blümel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
mesh_terms: D000368:Aged; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D019468:Disease Management; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D015397:Program Evaluation; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome