OBJECTIVE: To determine whether clinical outcomes in patients with type 2 diabetes were improved by protocol-driven care in a Diabetes Centre compared with usual outpatient care. STUDY DESIGN: Descriptive analysis of a prospective cohort. PATIENTS AND METHODS: During a median 7-year observational period, 91 patients with type 2 diabetes and no cardiovascular or renal complications were monitored by a nurse and a diabetologist in a clinical trial setting according to a structured protocol. Another 81 patients with comparable clinical characteristics were monitored by generalists at the medical clinic in the same hospital. Clinical end points, defined as death and cardiovascular and renal events, were evaluated in 1997 by review of case records. RESULTS: Patients receiving structured care had lower mortality (relative risk [RR] = 0.21; 95% confidence interval [CI] = 0.07, 0.65; P = .006) than the usual-care group, as well as a lower incidence of combined clinical end points (RR = 0.43; 95% CI = 0.22, 0.84; P = .01). In the usual-care group, patients who had no monitoring of glycosylated hemoglobin or plasma lipid levels during the entire observational period (8.6%) had a 14.6-fold (P < .01) and 15.7-fold (P < .01) increased risk of death and combined clinical end points, respectively, compared with those who had at least one measurement (60.5%). CONCLUSION: Management by protocol-driven care model improved survival and clinical outcomes in patients with type 2 diabetes. Definitive studies are required to confirm these findings and compare the cost effectiveness of these care models.
RCT Entities:
OBJECTIVE: To determine whether clinical outcomes in patients with type 2 diabetes were improved by protocol-driven care in a Diabetes Centre compared with usual outpatient care. STUDY DESIGN: Descriptive analysis of a prospective cohort. PATIENTS AND METHODS: During a median 7-year observational period, 91 patients with type 2 diabetes and no cardiovascular or renal complications were monitored by a nurse and a diabetologist in a clinical trial setting according to a structured protocol. Another 81 patients with comparable clinical characteristics were monitored by generalists at the medical clinic in the same hospital. Clinical end points, defined as death and cardiovascular and renal events, were evaluated in 1997 by review of case records. RESULTS:Patients receiving structured care had lower mortality (relative risk [RR] = 0.21; 95% confidence interval [CI] = 0.07, 0.65; P = .006) than the usual-care group, as well as a lower incidence of combined clinical end points (RR = 0.43; 95% CI = 0.22, 0.84; P = .01). In the usual-care group, patients who had no monitoring of glycosylated hemoglobin or plasma lipid levels during the entire observational period (8.6%) had a 14.6-fold (P < .01) and 15.7-fold (P < .01) increased risk of death and combined clinical end points, respectively, compared with those who had at least one measurement (60.5%). CONCLUSION: Management by protocol-driven care model improved survival and clinical outcomes in patients with type 2 diabetes. Definitive studies are required to confirm these findings and compare the cost effectiveness of these care models.
Authors: Gary T Ko; Wing-Yee So; Peter C Tong; Francois Le Coguiec; Debborah Kerr; Greg Lyubomirsky; Beaver Tamesis; Troels Wolthers; Jennifer Nan; Juliana Chan Journal: BMC Med Inform Decis Mak Date: 2010-05-13 Impact factor: 2.796
Authors: Alice P S Kong; Gang Xu; Nicola Brown; Wing-Yee So; Ronald C W Ma; Juliana C N Chan Journal: Nat Rev Endocrinol Date: 2013-05-28 Impact factor: 43.330
Authors: Margaret McGill; Lawrence Blonde; Juliana C N Chan; Kamlesh Khunti; Fernando J Lavalle; Clifford J Bailey Journal: J Clin Transl Endocrinol Date: 2016-12-09
Authors: G E Tutino; W Y Yang; X Li; W H Li; Y Y Zhang; X H Guo; A O Luk; R O P Yeung; J M Yin; R Ozaki; W Y So; R C W Ma; L N Ji; A P S Kong; J P Weng; G T C Ko; W P Jia; J C N Chan Journal: Diabet Med Date: 2016-07-11 Impact factor: 4.359
Authors: Alexander Bischoff; Tetanye Ekoe; Nicolas Perone; Slim Slama; Louis Loutan Journal: Int J Environ Res Public Health Date: 2009-08-14 Impact factor: 3.390
Authors: Juliana C Chan; Wing-Yee So; Chun-Yip Yeung; Gary T Ko; Ip-Tim Lau; Man-Wo Tsang; Kam-Piu Lau; Sing-Chung Siu; June K Li; Vincent T Yeung; Wilson Y Leung; Peter C Tong Journal: Diabetes Care Date: 2009-06 Impact factor: 19.112