DIABEDS: A randomized trial of the effects of physician and/or patient education on diabetes patient outcomes

Vinicor, Frank; Cohen, Stuart J.; Mazzuca, Steven A.; Moorman, Nicky; Wheeler, Madelyn L.; Kuebler, T.; Swanson, Seegar; Ours, P; Fineberg, S. Edwin; Gordon, Elisa

doi:10.1016/0021-9681(87)90050-6

Cited by 105 publications

(48 citation statements)

References 26 publications

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“…Similar baseline measurements between intervention and control groups were reported in only 13 of 42 studies (21,24,(27)(28)(29)40,44,52,55,56,61,64,66). Outcomes were assessed blindly or were objective (assessed by a standardized test) in 21 studies (22)(23)(24)(27)(28)(29)(30)33,34,36,40,41,47,51,52,56,58,60,61,63,66).…”

Section: Study Qualitymentioning

confidence: 78%

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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OBJECTIVE -To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS-A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used.RESULTS -A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care.CONCLUSIONS -Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care. Diabetes Care 24:1821-1833, 2001D iabetes is a major and growing health care problem. Primarily because of the increasing prevalence of type 2 diabetes as well as the increase in cases of type 1 diabetes (1), it is expected that the number of people with diabetes will double by the year 2010 (2).Diabetes accounts for a huge burden of morbidity and mortality through micro-and macrovascular complications (3,4). However, it is now clear that strict control of blood glucose, blood pressure, and cholesterol can reduce the risk of diabetes-related complications (5-8). To achieve strict control, structured care is needed (9).Over the past 20 years, the responsibility for the care of people with diabetes has shifted away from hospitals to primary care (10,11). During this period, randomized trials have demonstrated that if regular review of patients is guaranteed, the standard of primary care can be as good or better than hospital outpatient care in the short term (9). Several guidelines and diabetes management programs have been developed nationally and locally to improve diabetes care in the community. However, empirical data suggest that compliance with diabetes clinical practice recommendations is inadequate in primary care (12)(13)(14...

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Section: Study Qualitymentioning

confidence: 78%

“…In 14 (20,21,23,28,29,31,39,44,(51)(52)(53)58,59,64) of these, the guidelines were locally developed, in 11 studies (22,24,26,27,32,35,36,47,55,57,60) they were based on national guidelines, and in 2 studies (46,54) the source of the guidelines was not specified.…”

Section: Discussionmentioning

confidence: 99%

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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“…Some studies demonstrated a decrease in systolic blood pressure (Ϫ4 mmHg) (28) and diastolic blood pressure (Ϫ3 to -8 mmHg) (27)(28)(29)76), whereas others showed no significant changes (34,73,82,89).…”

Section: Continued On Following Pagementioning

confidence: 99%

Effectiveness of Self-Management Training in Type 2 Diabetes

2001

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OBJECTIVE -To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS -MEDLINE, EducationalResources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization.RESULTS -A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of selfmonitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (Ͻ6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined healthcare utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited.CONCLUSIONS -Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life. Diabetes Care 24:561-587, 2001D iabetes self-management training, the process of teaching individuals to manage their diabetes (1), has been considered an important part of clinical management since the 1930s (2). The goals of diabetes education are to optimize metabolic control, prevent acute and chronic complications, and optimize quality of life while keeping costs acceptable (3). One of the goals of Healthy People 2010 is to increase to 60% (from the 1998 baseline of 40%) the proportion of individuals with diabetes who receive formal diabetes education (4). There are significant knowledge and skill deficits in ...

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“…diabetics [7], asthmatics [2,8], elderly patients [3,9,10], and patients with hypertension [11]. To our knowledge, no randomized controlled studies have been published on pharmacy-based interventions targeting inappropriate triptan use.…”

mentioning

confidence: 99%

Intensive community pharmacy intervention had little impact on triptan consumption: A randomized controlled trial

Søndergaard

Foged

Kragstrup

et al. 2006

Scandinavian Journal of Primary Health Care

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DIABEDS: A randomized trial of the effects of physician and/or patient education on diabetes patient outcomes

Cited by 105 publications

References 26 publications

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Effectiveness of Self-Management Training in Type 2 Diabetes

Intensive community pharmacy intervention had little impact on triptan consumption: A randomized controlled trial

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