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Impact of a chronic care model based on patient empowerment on the management of Type 2 diabetes: effects of the SINERGIA programme.
- Source :
-
Diabetic Medicine . Jun2011, Vol. 28 Issue 6, p724-730. 7p. 1 Diagram, 2 Charts. - Publication Year :
- 2011
-
Abstract
- Aims Several chronic care models for diabetes have been implemented in Italy, although conclusive data on their effectiveness are lacking. In the Cusano-Milanino diabetes clinic, patients with Type 2 diabetes with a stable disease/therapy (i.e. a steady level of HbA1c without need for therapy changes) are included in the SINERGIA programme: diabetologists, nurses and dietitians empower patients and telemedicine resources are utilized efficiently. Methods Clinical outcomes measured in the year before and after the initiation of SINERGIA were compared. A generalized hierarchical linear regression model for repeated measures was used. Results Altogether, 1004 patients were included; baseline characteristics were (mean ± SD): age 66.6 ± 6.2 years, 54.1% male, diabetes duration 10.8 ± 7.7 years, BMI 29.5 ± 4.8 kg /m², HbA1c 6.9 ± 0.9% (52 ± 14 mmol/ mol); 72.9% of patients were treated with anti-hypertensive drugs; 32.7%were treated with lipid-lowering drugs. After a median follow-up of 12 months (range 6-24 months), the proportion of patients with HbA1c ≤ 7.0% (≤ 53 mmol/mol) increased from 32.7 to 45.8%(P < 0.0001), while those with HbA1c ≥ 9%(≥ 75 mmol/mol) decreased from 10.5 to 4.3%(P < 0.0001). Patients with LDL cholesterol < 100 mg/dl (< 2.59 mmol/l) increased from 40 to 47% (P < 0.0001), while those with LDL cholesterol ≥ 130 mg/dl (≥ 3.36 mmol/l) decreased from 26.6 to 19.7%; blood pressure levels were slightly improved. The mean number of face-to-face encounters decreased from (median and range) 2.8 (2.3-3.4) to 2.3 (1.9-2.7) (P < 0.0001) visits per patient/year. Conclusions The SINERGIA model is effective in improving metabolic control and major cardiovascular risk factors, while allowing diabetologists to dedicate more time to patients with more acute disease. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ANTIHYPERTENSIVE agents
*ANTILIPEMIC agents
*BLOOD pressure
*COMPUTER software
*CONFIDENCE intervals
*DECISION making
*DIABETES
*GLYCOSYLATED hemoglobin
*LONGITUDINAL method
*LOW density lipoproteins
*METABOLIC regulation
*TYPE 2 diabetes
*HEALTH outcome assessment
*PATIENT education
*LEGAL status of patients
*REGRESSION analysis
*HEALTH self-care
*SELF-efficacy
*STATISTICAL hypothesis testing
*DATA analysis
*TREATMENT effectiveness
*PRE-tests & post-tests
*REPEATED measures design
*EVALUATION of human services programs
Subjects
Details
- Language :
- English
- ISSN :
- 07423071
- Volume :
- 28
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Diabetic Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 60602248
- Full Text :
- https://doi.org/10.1111/j.1464-5491.2011.03253.x