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Cited by 141Diabetes Management and EducationChronic Disease Management StrategiesPrimary Care and Health Outcomes

The DOI matches its Crossref record; 29 of the 30 references it cites were found in a registry or an index.

The effectiveness of the Austrian disease management programme for type 2 diabetes: a cluster-randomised controlled trial

Open access
Sönnichsen, Andreas C, Winkler, Henrike, Flamm, Maria, Panisch, Sigrid, Kowatsch, Peter, Klima, Gert, Fürthauer, Bernhard, Weitgasser, Raimund·2010·BMC Family Practice
DOI 10.1186/1471-2296-11-86PMC PMC2989935
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Abstract

BACKGROUND: Disease management programmes (DMPs) are costly and impose additional work load on general practitioners (GPs). Data on their effectiveness are inconclusive. We therefore conducted a cluster-randomised controlled trial to evaluate the effectiveness of the Austrian DMP for diabetes mellitus type 2 on HbA1c and quality of care for adult patients in primary care. METHODS: All GPs of Salzburg-province were invited to participate. After cluster-randomisation by district, all patients with diabetes type 2 were recruited consecutively from 7-11/2007. The DMP, consisting mainly of physician and patient education, standardised documentation and agreement on therapeutic goals, was implemented in the intervention group while the control group received usual care. We aimed to show superiority of the intervention regarding metabolic control and process quality. The primary outcome measure was a change in HbA1c after one year. Secondary outcomes were days in the hospital, blood pressure, lipids, body mass index (BMI), enrolment in patient education and regular guideline-adherent examination. Blinding was not possible. RESULTS: 92 physicians recruited 1489 patients (649 intervention, 840 control). After 401 ± 47 days, 590 intervention-patients and 754 controls had complete data. In the intention to treat analysis (ITT) of all 1489 patients, HbA1c decreased 0.41% in the intervention group and 0.28% in controls. The difference of -0.13% (95% CI -0.24; -0.02) was significant at p = 0.026. Significance was lost in mixed models adjusted for baseline value and cluster-effects (adjusted mean difference -0.03 (95% CI -0.15; 0.09, p = 0.607). Of the secondary outcome measures, BMI and cholesterol were significantly reduced in the intervention group compared to controls in ITT after adjustments (-0.53 kg/m²; 95% CI -1.03;-0.02; p = 0.014 and -0.10 mmol/l; 95% CI -0.21; -0.003; p = 0.043). Additionally, more patients received patient education (49.5% vs. 20.1%, p < 0.0001), eye- (71.0% vs. 51.2%, p < 0.0001), foot examinations (73.8% vs. 45.1%, p < 0.0001), and regular HbA1c checks (44.1% vs. 36.0%, p < 0.01) in the intervention group. CONCLUSION: The Austrian DMP implemented by statutory health insurance improves process quality and enhances weight reduction, but does not significantly improve metabolic control for patients with type 2 diabetes mellitus. Whether the small benefit seen in secondary outcome measures leads to better patient outcomes, remains unclear. TRIAL REGISTRATION: Current Controlled trials Ltd., ISRCTN27414162.

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Figure 1 Flow of Clusters and Participants.
Figure 1 Flow of Clusters and Participants.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. Berger M, Grüßer M: Behandlungs- und Schulungsprogramm fürTyp 2 Diabetiker, die nicht Insulin spritzen. Deutscher Ärzteverlag, Köln. 1997
  2. Weitgasser R, Aistleitner M, König C, Rakovac I, Habacher W: Diabetesschulung "Neu" für Patienten mit Typ-2-Diabetes im Land Salzburg. Diabetes, Stoffwechsel und Herz. 2009, 18: 25-27.
  3. Österreichische Diabetes Gesellschaft: [Diabetes mellitus--guidelines for general practice. Revised and expanded 2007 edition]. Wien Klin Wochenschr. 2007, 119: 5-64.

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Metadata

Authors
Sönnichsen, A. C., Winkler, H., Flamm, M., Panisch, S., Kowatsch, P., Klima, G., Fürthauer, B., & Weitgasser, R.
Affiliations
  • Paracelsus Medical University (AT)
  • Private Pädagogische Hochschule Augustinum (AT)
Corresponding author
Sönnichsen, Andreas C
ORCID
Venue
BMC Family Practice
Publisher
Springer Science and Business Media LLC
Published
2010-11-05
Volume
11
Issue
1
Pages
86-86
ISSN
1471-2296 (ISSN-L)
DOI
10.1186/1471-2296-11-86
PMC
PMC2989935
OpenAlex
W2057504267
Cited by
141
References
30
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 13 · 2022: 4 · 2021: 2 · 2020: 5 · 2019: 1 · 2018: 6 · 2017: 2 · 2016: 3 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 41
FWCI
22.20
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Universität Heidelberg
  • Paracelsus Medizinische Privatuniversität
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Keywords
type 2 diabetes, disease management programs, primary care, HbA1c, glycemic control, quality of care, patient education, physician training, treatment goals, body mass index, cholesterol, hospitalization, guideline adherence, cost-effectiveness, general practitioners, diabetes self-management education
MeSH terms
Adult, Austria, Diabetes Mellitus, Type 2, Female, Health Plan Implementation, Glycated Hemoglobin, Humans, Male, Program Development, Disease Management

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