Structured primary care for type 2 diabetes has positive effects on clinical outcomes

Abstract

Background: Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved. Objective: The aim of the study was to evaluate the effects of structured diabetes care on clinical outcomes of patients with type 2 diabetes in primary care. Methods: We performed a quasi-experimental study on the effects of structured care consisting of organizational and educational components (n = 581) compared with care-as-usual (n = 152). We assessed clinical outcomes of HbA1c, blood pressure, cholesterol, creatinine and body mass index, at baseline and after 1 year. The long-term effects in the structured care group were determined after another 2 years. Results: Structured care led to improvement in HbA1c and long-term improvements in blood pressure and cholesterol compared with care-as-usual. After 1 year, the percentage of patients who did not deteriorate was higher in the structured care group, again for HbA1c, diastolic blood pressure, low-density lipoprotein cholesterol and body mass index. Conclusions: Structured diabetes care consisting of multiple components has a positive effect on clinical outcomes compared with care-as-usual. Our findings support its further implementation in order to reduce complications in type 2 diabetes patients. © 2010 Blackwell Publishing Ltd.