Most Diabetes Programs Do Their Job

Diabetes prevention and management programs work best if targeted at patients and healthcare system

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Even though the rate of type 2 diabetes is growing quickly, the disease can be prevented. Simple lifestyle choices can change the course of diabetes. To fight diabetes, patients often need more support and access to care.

Diabetes prevention or treatment programs work better if they focus on the patient or the healthcare system rather than on doctors. Programs directed towards the doctors were only effective for patients with poor diabetes control.

"Make healthy lifestyle choices to prevent or manage diabetes."

Andrea Tricco, PhD, of the Li Ka Shing Knowledge Institute at St. Michael's Hospital in Toronto, and colleagues recently reviewed 142 studies to examine the outcomes of diabetes prevention and management programs.

Results from many clinical trials show that diabetes patients who receive preventive and treatment interventions have better outcomes. According to Dr. Tricco, many patients do not receive such interventions.

"The gap between ideal and actual care is not surprising in view of the complex nature of diabetes management, often needing coordinated services of primary care physicians, allied health practitioners, and sub-specialists," says Dr. Tricco.

In other words, successful diabetes care often requires doctors, diabetes specialists, and other healthcare professionals to work together.

"Moreover, it is a challenge to change patient behavior and encourage healthy lifestyles," she says.

From their review of more than 123,000 patients, Dr. Tricco and colleagues found that certain interventions aimed at the healthcare system are effective for patients with high levels of HbA1c - a measure of blood sugar over three months.

Interventions directed at the healthcare system include team changes and case management. Team changes are programs that add another specialist, such as an endocrinologist or nutritionist, to a patient's healthcare team. Patients involved in case management programs have their care coordinated by someone other than their doctor, such as a nurse.

Results from trials show that strategies targeting the healthcare system reduced patients' heart disease risk factors, such as LDL cholesterol ("bad" cholesterol) and blood pressure.

The researchers also found that interventions aimed at patients are successful, no matter their HbA1c levels.

Interventions directed at physicians, however, were not as successful. These interventions were especially ineffective for patients who already had their diabetes fairly well-controlled.

According to Dr. Tricco, doctors and policy makers spend a lot of time and resources trying to bring the best care possible to diabetes patients. Yet they are still uncertain about the best way to improve diabetes care and patient outcomes.

This study's results, says Dr. Tricco, could help doctors determine which patients would benefit most from which interventions. For example, more expensive programs like team changes and case management might be useful for patients with poor diabetes control. 

The overall results of the study show that quality improvement interventions - such as clinical reminders, clinical education, patient behavior and patient education - reduced patients' HbA1c by about 0.37 percent after an average of one year.

This finding is important, as lowering HbA1c by just one percent may reduce diabetes-related deaths by 21 percent and heart attacks by 14 percent.

Dr. Tricco says more research is needed to see which interventions and combinations of interventions will improve outcomes for diabetes patients without becoming too costly for patients and the healthcare system.

The current study is published in The Lancet.

Reviewed by: 
Review Date: 
June 25, 2012
Last Updated:
November 27, 2012